[show abstract][hide abstract] ABSTRACT: Unanticipated difficult tracheal intubation is a significant source of morbidity and mortality in anesthetized patients. A number of modules have been developed to predict difficult airways, but they are often complex in nature. We combined the modified Mallampati score (M), thyromental distance (T), anatomical abnormality (A), and cervical mobility (C) into a single scoring system with the acronym M-TAC, and evaluated it against Mallampati scoring.
We prospectively analyzed 500 adult patients of the American Society of Anesthesiologists (ASA) class I or II, scheduled for elective surgery under general anesthesia. Preoperative airway assessments using M-TAC were performed, all of which were given a score. Anesthesiologists, blinded to the pre-anesthetic airway assessment, performed laryngoscopy and graded the laryngoscopic view as per Cormack and Lehane's classification. For the study purpose, difficult laryngoscopy was defined as Cormack and Lehane Grade 3 or 4 of laryngoscopic view.
An M-TAC score ≥ 4 had a significantly higher sensitivity (96% vs. 72%) and specificity (86% vs. 78%) with a high positive predictive value (44% vs. 28%) and a very low false negative value (2% vs. 15%) in comparison with Mallampati scoring (p < 0.05). Analysis of the receiver operating characteristic (ROC) curve for predicting difficult laryngoscopy revealed an area under the curve of 0.83 (95% CI = 0.78-0.88) for Mallampati scoring and 0.94 (95% CI = 0.92-0.96) for M-TAC scoring system.
The M-TAC scoring system has provided a higher sensitivity and specificity in predicting difficult laryngoscopy in comparison with Mallampati classification.
Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists. 06/2013; 51(2):58-62.
[show abstract][hide abstract] ABSTRACT: Encephalocele is a form of neural tube defect, characterized by protrusion out of the meninges and brain tissue through a bony skull defect. As per the site of origin, these encephaloceles have been classified into different types, out of which the frontoethmoidal one is exclusively common in Southeast Asia with a reported incidence of 1 in 5,000. Neurological outcome of such malformations depends on the size of the sac, neural tissue content, hydrocephalus, associated infection, and other pathologies that accompany this condition. Here we describe the anaesthetic concerns and perioperative management of a giant occipital encephalocele.
[show abstract][hide abstract] ABSTRACT: Interference of monitored electrocardiogram (ECG) is a common event in intensive care units and operation theaters. Artifacts in the ECG tracing can resemble serious arrhythmia, thus leading to unnecessary usage of antiarrhythmics or electrical defibrillation. In addition, ECG artifacts may lead to serious hemodynamic consequences secondary to intra-aortic balloon pump (IABP) trigger failure. We report a rare event of IABP failure due to ECG artifact, which appeared on placement of the transthoracic echocardiography probe over the chest. Subsequent evaluation revealed potential current leakage from echocardiography machine secondary to earthing defect in the machine.
Annals of Cardiac Anaesthesia 01/2012; 15(1):47-9.
[show abstract][hide abstract] ABSTRACT: Background and aims. Approximately 20% of acute pancreatitis progresses to a severe form characterised by multiple
extrapancreatic organ dysfunction. Elevated intra-abdominal pressure (IAP), a frequent finding in these patients, further adds to
the mortality. Currently used prognostication indices have their own set of limitations. We evaluated IAP at intensive care unit
(ICU) admission as a predictor of mortality in severe acute pancreatitis (SAP).
Methods. A retrospective analysis of 50 patients with SAP admitted to the ICU of a tertiary-care Indian institute over a period of
3 years was done. Data relating to demographic profile, cause of pancreatitis, ICU admission, Acute Physiology and Chronic Health
Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, IAP, interventions instituted and mortality
Results. Biliary stones (38%) were the most common cause of acute pancreatitis. Survivors differed from non-survivors with
respect to organ failure, APACHE II and SOFA scores and IAP on admission. There was a significant correlation between IAP on ICU
admission and admission SOFA (r=0.56, p<0.001) and APACHE II (r=0.54, p<0.001) in predicting mortality. Patients with elective
admission had a mortality rate of 53% (20/38) compared to 83% (10/12) for those admitted as emergencies. Analysis of receiver
operating characteristic curves for detecting mortality revealed an area under the curve of 0.915 (95% confidence interval (CI)
0.83 - 0.99) for IAP, 0.826 (95% CI 0.71 - 0.93) for SOFA, and 0.831 (95% CI 0.71 - 0.94) for APACHE II.
Conclusion. IAP at ICU admission is a useful predictor of severity of illness and mortality in SAP.
Southern African Journal of Critical Care 01/2012; 28(1):17-21.
[show abstract][hide abstract] ABSTRACT: Cholecystectomy represents the second most common surgery during pregnancy. Both general and regional anesthetic techniques have been successfully used for cholecystectomy in pregnant patients. Authors present here a case of a pregnant patient carrying twin gestation who underwent cholecystectomy, which is not frequently encountered by the anesthesiologists. This report enumerates the perioperative issues relating to anesthesia given to a pregnant patient in addition to emphasizing the importance of multidisciplinary approach when such a case is encountered.