Day 1 :
- Types of Anesthesia
Location: San Antonio
Associate Professor in Anaesthesiology at Regional Cancer Centre, Trivandrum, Kerala, India
Dr Sudha P is an Associate Professor in Anaesthesiology at Regional Cancer Centre, Trivandrum, Kerala, India
She has Post graduate Degree (M.D) and Diploma in Anaesthesiology (DA),Post Graduate diploma in Health and Hospital Administration (PGDHHA) and degree of Master of Hospital Administration(MHA), from the University of Kerala, India
Her Areas of professional Interest are Pain management, Regional Anaesthesia, Nerve Blocks, and Hospital Management. She was awarded UICC: ICRETT fellowship thrice for doing projects in MD Anderson Cancer Centre, Houston, Texas, Memorial Sloan Kettering Cancer Centre, Newyork and TJ Samson Community Hospital, Glasgow, Kentucky.
She has publications in reputed Indian and International journals
Background: Numerous factors affect the risk of recurrence and metastasis after cancer surgery. Studies have observed that anaesthetic techniques have effects on tumour recurrence.
Methods: Medical records of newly diagnosed ovarian serous adenocarcinoma patients who underwent radical hysterectomy with bilateral salpingoopherectomy from 1995-2008 were analysed for the effect of anaesthetic techniques and drugs on tumour recurrence & metastasis free survival rate and mortality rate. Univariate association between overall survival and anaesthesia technique was assessed using Kaplan-Meier survival estimates and Cox regression. Multivariate association was tested after adjusting potential confounding factors.
Results: The overall survival rate (RR at 95% CI=3.16(1.79-5.60) was significantly better in patients who received regional anaesthesia for surgery than those who had general anaesthesia. Other factors significantly associated with overall survival rate in univariable analysis were,perioperative blood transfusion,preoperative Ca 125 level, FIGO stage, tumour size and lymphatic metastasis.Kaplan Meier survival curve showed that regional anesthesia group had higher overall survival rate.Recurrence rate did not show significant difference in univariable(Odds 95% CI 1.42 P = 0.273)and multivariable(Odds 95% CI = 0 P = 0.846) analysis.Al1the 18 patients who had metastasis underwent surgery under GA.
Conclusions: This study showed marked increase in overall survival rate in patients who underwent surgery under regional anaesthesia when compared to those who had surgery under general anaesthesia. Prospective randomized control trials are needed for better evaluation.
- Anesthesia and acute pain management
Location: San Antonio
Dr. Parul Maheshwari is currently working as an Assistant Professor in the Department of Anesthesiology, University of Oklahoma Health Sciences Center, USA, a multispecialty, tertiary care hospital and is the only Level 1 trauma center in the state of Oklahoma. Dr. Maheshwari completed her Anesthesiology residency and Cardiothoracic and Vascular Anesthesiology fellowship at University of Texas Health Science Center, Houston. She is a Diplomate of American Board of Anesthesiology and National Board of Echocardiography. She has been extensively involved with teaching and mentorship of students, residents, and fellows. She has been a member of departmental and hospital committees. She is an editorial board member for Journal of International Archives of Clinical Anesthesia Research and has numerous peer reviewed publications.
Pain is one of the main predictable postoperative adverse outcome and is reason for distress in patients. Adequate pain control is important for perioperative period. Any single analgesic may not be capable of providing best pain control with minimum or no side effect. Multimodal analgesia is combining different entities to decrease pain as well as the side effects of medications and improve patient satisfaction. Combination of drugs allow modulation of pain at various points in the neurochemical pathway, resulting in synergistic and/or additive analgesia which is corner stone of multimodal analgesia. Multimodal analgesia not only decreases pain and discomfort, but also decreases over all cost by decreasing length of stay.
My talk will focus on concepts of multimodal analgesia, its advantages, different modalities used and its impact on patient care.
- Intensive Care Medicine and Organ Support Systems
Location: San Antonio
Elizabeth McIntyre, Beaumont Health System, USA
Elizabeth McIntyre completed her MD at the University of Toledo in 2013. She is currently in anesthesia residency at Beaumont Health System in Royal Oak, MI. After residency, she will attend critical care fellowship at Northwestern University in Chicago, IL.
Critical aortic stenosis (AS) is a rare and lifethreatening complication in pregnancy. Tachycardia in pregnancy increases cardiac output while decreasing ventricular filling time, which is deleterious in AS. Physicians often recommend termination of pregnancy for the sake of maternal health. In this case, critical AS diagnosed at 17 weeks gestational age (GA) was treated with emergent replacement of the aortic valve at 21 weeks GA with survival of mother and fetus.
A 35 year old multiparous female at 17 weeks GA with past medical history of gestational hypertension and hyperlipidemia presented emergently with dyspnea on exertion and newly diagnosed left bundle branch block. The patient was found to have critical AS and moderate aortic regurgitation by transthoracic echo. She was admitted to the cardiac intensive care unit for medical management until the fetus reached viability. At 21 weeks GA, the patient acutely decompensated, experiencing a 4 minute asystolic episode and receiving cardiopulmonary resuscitation. Multidisciplinary discussions led by the intensivist resulted in emergent coronary artery bypass grafting as well as an aortic valve replacement and aortic root endarterectomy with survival of mother and fetus.
Multidisciplinary discussions organized and executed by the critical care intensivist are imperative for appropriate and timely treatment of AS in the parturient patient. In mild AS, parturients may betreated with medical therapy and expectant management until delivery, after which the valve can be surgically repaired. In more severe cases, symptomatic AS in pregnancy may be treated with balloon valvuloplasty. In this case, conservative management was first attempted. The parturient also did not qualify for balloon valvuloplasty or TAVR due to concurrent moderate to severe AR. However, acute decompensation in the patient’s cardiac status required emergent surgical intervention at 21 weeks GA. Intensivists managing parturients with severe symptomatic AS should consider surgical replacement and initiate multidisciplinary coordination between obstetricians and cardiothoracic surgeons.
University of Benin Teaching Hospital, Nigeria
Ochukpue Ceejay he works in the department of Anaesthesiology, in University of Benin Teaching Hospital, Benin City, Nigeria
Background/Purpose: The need for ventilatory support is one of the commonest indications for admission into the intensive care unit (ICU). Despite the usefulness of mechanical ventilation, its damaging effect on the lungs has also been widely recognized in the literature.
Methods: The study was a prospective, case-control survey of all mechanically ventilated patients admitted in our ICU from November 2013 to April 2014. For every ventilated patient, a non-ventilated similar patient served as a control.
Results: A total of 128 patients were admitted into the ICU over the six month period and 44 patients constituting 34.4% were mechanically ventilated. The average duration of mechanical ventilation was 12.30±10.10 days. Duration of mechanical ventilation, use arterial of arterial blood gas measurement and ionotropic support had significant effect on weaning from ventilation with p values of 0.005, 0.05 and <0.001 respectively. Mechanically ventilated patients had >4 times chance of death than non-ventilated patients.
Conclusions: Mechanical ventilation, though, a useful therapeutic intervention in the ICU is associated with increased mortality. Duration of ventilation, use of arterial blood gas (ABG) and need for ionotropic support influenced successful weaning off ventilator. It may be expedient therefore to weigh risk: benefit assessment of mechanical ventilation before commencement in the ICU.
- Adult Subspecialty Management
Location: San Antonio
Dr. Praveen Maheshwari is currently working as an Assistant Professor in the Department of Anesthesiology, University of Oklahoma Health Sciences Center, USA, a multispecialty, tertiary care hospital and is the only Level 1 trauma center in the state of Oklahoma. Dr. Maheshwari completed his Anesthesiology residency and Cardiothoracic and Vascular Anesthesiology fellowship at the University of Texas Health Science Center, Houston. He is a Diplomate of American Board of Anesthesiology and National Board of Echocardiography. He has been actively involved with teaching and mentorship of students, residents, and fellows. He has been a member of numerous departmental and hospital committees. He is a question writer for American Society of Anesthesiology and a junior editor for American Board of Anesthesiology. He has been invited to present lectures at regional meetings and have done presentations at national and international meetings. He has numerous peer reviewed publications. He is an editorial board member and is a peer reviewer for several Anesthesiology journals.
Prevalence of obesity is increasing all over the world. Obese patients are not just large but they also have multiple physiological and anatomical changes associated with obesity. These patients have multiple co morbidities associated with obesity which are independent predictors of poor outcome in the perioperative period. Obesity has its effect on bolus dosing and infusions of medications. Obesity makes these patients at higher risk for anesthesia. So it is very important for anesthesiologists to know about all these changes and how to manage these patient safely and efficiently in the perioperative period.
The aim of my talk is to understand the magnitude of the problem, anatomical and physiological changes of obesity, comorbidities associated with obesity, their effect on anesthesia and their management in the perioperative period.
University of Benin Teaching Hospital, Nigeria
Age itself is not a disease process but may be associated with age related diseases. However, with increasing age, the incidence and mortality is higher.1
MATERIALS AND METHODS: Data was collected over a 13-year period (1997 -2010) for patients aged 60 years and above, undergoing both elective and emergency cases after approval from the Institution’s Ethics Committee. The study determined the patient’s demographics and characteristics, indication for surgery, grade of anaesthesia provider and analysed data using SPSS version 20.
RESULTS: There was a total of 1530 elderly patients within the 13-year study period. The mean age was 69.7 ± 7. 7 years with a modal age of 60 years. 64.9% of the study population were males. Most of the surgical cases were for cataract excision (28.3%) and malignancies (13.6%) under local anaesthesia (49.6%) and general anaesthesia (38.9%) respectively. Regional anaesthetic techniques were more commonly employed than general anaesthesia (p = 0.037, RR = 3.1, 95% CI 1.2 – 8). Consultant anaesthetists (15.8%), senior registrars (74.7%) and registrars (9.5%) provided anaesthesia for the geriatric population. Adverse outcomes recorded were hypotension (4.1%), haemmorhage (2.2%) and cardiac arrest (0.3%).
CONCLUSION: A high proportion of the anaesthetic care is for the elderly. There was a three-fold chance of regional anaesthesia than general anaesthesia for surgical procedures in the elderly. Although regional anaesthesia accounts for a high proportion of anaesthetic options, consultant anaesthetists should be more involved in the care of the elderly.