ISA- ALL BY MYSELF AWARD
Indian Journal of Anaesthesia · 2023
NO.: ABS0036 Anaesthesiologist - A critical brick in the wall of disaster management Lt Col Rijesh R Unnithan Armed Forces Medical College, Pune Description: Mass casualty events present an acute, critical situation that taxes healthcare resources and clinical acumen even for doctors in the Armed Forces. Disaster struck a party of soldiers travelling in a bus on the high-altitude terrain in Ladakh when it skidded off the road and fell into a ravine to a 30-metre-deep ravine. The incident had local and national ramifications. Out of 26 casualties received at the hospital, 07 were brought in dead, 05 were declared Priority-1(P1), and 14 were Priority-2 casualties. The most critical P1 case was of a 22-year-old male with craniofacial trauma. The airway was filled with blood, restricted mouth opening, and active bleeding. The patient had an anatomically difficult airway that I intubated on the 3rd attempt because of the manual in-line stabilisation, blood-filled airway and swollen glottis. Later, wire fixation of the maxilla and mandible fractures was carried out in the operating room under general anaesthesia. The critical care team, led by me, provided Damage Control Resuscitation to the remaining P1 casualties, including chest tube insertions. All survivors were safely evacuated to a tertiary care hospital by the Air Force, discharged later, and presently recuperated. As the lone anaesthesiologist serving in a hospital in a field setting at 10600 feet above sea level, with limited resources and difficult evacuation modes, I was instrumental in ensuring no further loss of lives. ABSTRACT NO.: ABS0040 Medevac of a cardiac arrest survivor: Off-base anaesthetic challenges Arun Kumar Patra Command Hospital Air Force, Bangalore Description: I received a call from one of the hospitals in Port Blair to transfer a patient to a tertiary care centre needing multi-disciplinary care. The patient had a cardiac arrest; he was resurrected, and spontaneous circulation was returned. However, he developed hypoxic ischemic encephalopathy requiring mechanical ventilation, Acute kidney injury and haemodynamic instability requiring multiple inotropic support. An air evacuation from Port Blair to Bangalore with an estimated flying time of 4h was planned. I led the medical team consisting of a nursing assistant and a lascar. We loaded oxygen cylinders, drugs and equipment in a specially designed patient transfer unit (PTU) for mid-air support. I faced challenges in properly fixing the aircraft’s PTU to avoid patient falls and setting up electric back-ups sufficient for running suction machines, portable ventilators, monitors and infusion pumps. I also informed the pilots to maintain a cabin pressure of less than 8000ft to minimise the haemodynamic alterations. On air, the patient had two episodes of seizures, hypertension and bradycardia, managed with appropriate drugs. The ventilator was not functioning as expected, and we manually ventilated the patient throughout the flying period. Before landing, I asked the pilots to contact the ground coordinators to place the ambulance appropriately to minimise the patient’s off-loading time. Planned and coordinated movement of all stakeholders helped us to shift the patient smoothly. ABSTRACT NO.: ABS0185 Endotracheal intubation in the prone position Sangamesh Kunakeri Bidar Institute of Medical Sciences Bidar Description: Endotracheal intubation in the prone position is a rarely attempted entity. There is a single publication in the literature regarding the same. Almost all spine surgeries are done in general anaesthesia. Regional anaesthesia for spine surgery is rarely attempted as there is a risk of conversion to general anaesthesia in the event of inadequate relaxation or early wearing in the middle of the surgery. With mastery in endotracheal intubation in the prone position (EIPP), this fear can be abolished, and spine surgeries can be done in regional anaesthesia. We are well aware of the benefits of regional anaesthesia over general anaesthesia. Routinely, we are doing spine surgeries at our institute in spinal anaesthesia with bupivacaine and clonidine. We have done around 108 spine surgeries, including single-level discectomy, laminectomy, micro-discectomy and single or two-level fixations. I present two cases where I intubated the patient in a prone position to convert from spinal to general anaesthesia. I recommend that spine surgeries be routinely done under regional anaesthesia with mastery and knowledge of EIPP. ABSTRACT NO.: ABS0255 Airway management in a low-resource setting Gowrishankar Anjaneyan Shaditya Hospital Description: I had a call from a low-resource hospital for airway management. A 55-year-old male with carcinoma oral cavity post radiotherapy was tachypnoeic and delirious. His heart rate(HR) was 144 beats per minute, oxygen saturation (SpO2) was 90% in room air, respiratory rate(RR) was 42 breaths per minute and non-invasive blood pressure(NIBP) was 80/50mmHg. Auscultation revealed bilateral crepitation. A provisional diagnosis of aspiration pneumonia was made, and he was initially started with 6 litres per minute of oxygen with a Hudson mask and later manually ventilated with a Bain circuit (SpO2 88%). Mask ventilation was not possible even after the insertion of Guedel’s airway. Awake trial laryngoscopy done with a Macintosh blade showed mass and bleeding from the oral cavity; even the epiglottis couldn’t be visualised. The patient developed bradycardia, and an injection of atropine 1.2 mg was given. SpO2 lowered to 65%, asystole followed, and a single cycle of cardiopulmonary resuscitation was administered to achieve spontaneous circulation. Emergency scalpel cricothyrotomy was contemplated. Due to thick fibrous neck tissues following radiotherapy, the cricothyroid membrane was identified with difficulty. No. 11 blade was used, a skin nick was placed, and the blade was introduced further inside to a depth of about 1 cm to let in a gush of air. Bougie was introduced, an endotracheal tube of 6 mm internal diameter was inserted, and the patient could be ventilated. SpO2 improved to 95%. He was connected to a transport ventilator and shifted to a tertiary centre. Percutaneous dilatational tracheostomy was later done, and he was shifted to palliative care. ABSTRACT NO.: ABS0415 A single-handed management for the doctor by the doctor Heena Sunil Chhanwal, Rekha Solanki GCS Medical College & Hospital, Ahmedabad Description: A 61-year-old male Paediatrician, my relative, collapsed suddenly at home. He was semi-conscious with a thready pulse. I shifted him to the nearest hospital with no imagining facilities. So, I moved him to Ahmedabad and accompanied him in the ambulance. After securing venous access and his primary treatment with fluids, we headed to Ahmedabad. I was informed that the ambulance was fully equipped. However, in a hurry and worried, I did not check it. On the way, he became unresponsive, with an absent pulse and breathing. Immediately, I started chest compressions and searched for an AMBU bag, but it was unavailable. The laryngoscope did not have batteries. I continued chest compressions and mouth-to-mouth breathing. He was revived with a palpable pulse. I was in touch with the neurosurgeon at Sterling Hospital, Ahmedabad, where he kept his team ready and after computerised tomography of the brain, he was diagnosed with subdural haemorrhage. He was managed conservatively without surgery and recovered completely. While giving cardiopulmonary resuscitation, I fell twice and got a calcaneum fracture, which required immobilisation with a cast for three weeks. The patient is still working at the age of 72 years. Such people inspire us and make our painful efforts worthy, and we feel complete and satisfied professionally. ABSTRACT NO.: ABS0573 Total spinal anaesthesia in a primigravida during lower segment caesarean section Kiran Janwe Government Medical College, Chandrapur, MH Description: Total spinal anaesthesia is a recognised complication of the central neuraxial block, with a high number being reported in obstetric cases. A sensory level of T3 or above can be associated with significant cardiovascular and respiratory compromise, which may culminate in complete loss of consciousness and cardiac arrest. A 24-year-old primigravida with a height of 158cms, weighing 65kgs, belonging to the American Society of Anesthesiologists physical class I, with no previous surgical or medical illness, was taken for emergency lower segment caesarean section for meconium-stained liquor. After proper monitoring and preloading the patient with Ringer’s lactate, a subarachnoid block was administered with 10mg of 0.5% heavy bupivacaine. The surgery started, and after two minutes, the patient suddenly complained of nausea, breathlessness, and hypotension. Gradually, the patient lost consciousness. Simultaneously, I started giving 100% oxygenation and vasoconstrictor drugs were given. I immediately intubated the patient and kept her on controlled ventilation. The baby was delivered and given bag and mask ventilation two minutes later. Spontaneous breathing was achieved, and he was transferred to the neonatal care unit for 24 hours of observation. The patient gained consciousness after seven minutes of intubation. She was maintained on spontaneous breathing with an endotracheal tube with counselling. The patient was extubated for a while after suctioning. Vitals were within normal limits throughout the procedure. In the postoperative period, the patient was kept in a high-dependency unit for observation. In this way, the total spinal anaesthesia was diagnosed and managed all by myself. ISA - DR. B.B. MISHRA YOUNG ANAESTHESIOLOGIST AWARD ABSTRACT NO.: ABS0106 Radiofrequency ablation in chronic pain. Shubha V Hegde, Mamatha C Bangalore Medical College Research Institute Description: Radiofrequency(RF) ablation/neurotomy is defined as the application of RF alternating electric current[low energy, high frequency(50-500Hz)] to the nerves [ultrasound/fluoroscopy guided] to ablate transmission of nociceptive signals. When applied to the tissues, molecules oscillate to produce sustained heat to cause thermocoagulation. There are various types of RF: continuous [constant current, 100-500Hz] and pulsed RF [short bursts: 50kHz at 20ms pulses at frequency 2Hz for 120s], monopolar, bipolar and cooled RF. Current indications for RF are the treatment of sacroiliac joint pain, facet joint pain, knee pain, sphenopalatine neuralgia, cluster headache, etc. RF has certain advantages over other neurolytic/ pain relief methods, including one-time procedures, longer duration of pain relief, and avoidance of steroid-related effects. ISA -THE INNOVATION AWARD ABSTRACT NO.: ABS0032 A mannequin-based training system for practicing sub-tenon’s block Jaichandran Venkatakrishnan, Nimal J kumar, Bobby George, Mohanasankar Sivaprakasam Sankara Nethralaya Description: Sub-tenon ophthalmic block (STB) is gaining popularity in ophthalmic anaesthesia. However, a training system for practising STB is not available so far. In this regard, our institutions have developed and clinically validated a mannequin-based training system for practising STB. An integrated, conductive silicone-based eye model sensor was designed. The simulator replicates the anatomy of the globe, the tenon membrane and the conjunctiva. The system is equipped with integrated sensors with new sensing schemes that can detect whether the cannula tip is in the correct plane and whether the tip is close to the optic nerve. The interface is displayed on a personal computer as colour indications. A red indication is presented for a cannula in the wrong plane (sub-conjunctival plane), and a green signal if the cannula is in the right plane. In the validated study, the system recorded 98.3 % accuracy in assessing the performed procedure, and the participants rated the naturality of the system with a score of 8.0 ± 0.63 (on a scale of 10) (P < 0.01). About 89 % of the participants preferred this training system for its usage of anatomically accurate models and effective warning systems that evaluate the performed procedure. This training system can be utilised as a teaching module and a practising tool to perform STB. This, in turn, can enable them to administer safe regional anaesthesia to their patients. ABSTRACT NO.: ABS. Innovative paediatric stylet from CopperT Kiran Janwe Government Medical College, Chandrapur, Maharashtra Description: Necessity is the Mother of all Inventions !! In 2015, when the government medical college started in the Chandrapur district of Maharashtra, we lacked a paediatric stylet in our intubation cart. The shape, size and structure of the solid rod, which comes along with the CopperT, had always fascinated me (Figure)—a solid rod of CopperT functions as a uterine sound. The advantages of the rod are that it has a blunt tip and is atraumatic. A loop is present at the user end for handling the rod. It has good flexibility and stability with a self-retaining shape. It is non-toxic and can be sterilised with ethylene oxide or formalin. This free-of-cost, readily available material can be used in term neonatal resuscitations with a body weight of 3 and above until six months of age. Introducing the white rod of CopperT into the 3.0 and 3.5 mm endotracheal tubes aided intubation (Figure). It has been a boon in many complex intubation cases, especially when we lacked the paediatric stylet. Difficult intubation is predicted in neonates because of the anatomical variation in the airway. Many studies have compared paediatric intubation with routine stylet and without stylet. The results favour using a stylet in difficult as well as routine intubation.Figure: CopperT with a rod and used as an intubation styletThis innovative Paediatric stylet from CopperT can be used as a substitute in those places and institutes where there is no proper paediatric stylet. “OM” (ONE MINUTE) SESSION AWARD ABSTRACT NO.: ABS0039 Inception of Robot technology in Pain practice Chetna Shamshery, Anil Agarwal, Sanjay Gambhir, Aftab Hasan Nazar SGPGIMS, Lucknow Summary: Robot assistance is well-established for surgical interventions but has yet to venture into anaesthesia and pain practices. Celiac plexus neurolysis (CPN)or superior hypogastric plexus neurolysis (SHPN) for pain palliation of gastrointestinal or gynaecologic cancer are conventionally performed using ultrasound, fluoroscope or computed tomography(CT). We present robot technology to achieve CT-guided CPN and SHPN for the first time. CT depicts the anatomical details three-dimensionally, whereas the robot uses those anatomical details precisely orients and gives coordinates for the accurate placement of the needle. Avoidance of visceral puncture is achieved by planning the trajectory by selecting entry and target points, which helps to locate the drug deposition site accurately. It ensures non-deviation from the targeted path as the needle is manually placed using the robotic arm, thus preserving the feel of tissue by the physician. ABSTRACT NO.: ABS0078 Impact of Noise Pollution in Operation Theatre Jyoti Petkar, S Rangalakshmi Rajarajeswari Medical College and Hospital, Bengaluru Summary: The recommended noise level in hospital areas should be 35-40 dB. The start and end of surgery, anaesthetic induction and emergence are noisy periods. Sources of noise include equipment-related background noise and verbal communication among staff and trainees (essential, like instructions, and like or background noise can the level of to this This to for the which can the and with communication and the of complex can be to and haemodynamic alterations. with and can during surgery. There can be to about noise and should be should be limited to those for patient care. a benefits and medical ABSTRACT NO.: Institute of Medical Sciences Summary: in with and of has been used during intubation using in an instability of the body and mouth cavity and injury to The of intubation using superior block, and is and in patients. The has the of being without a needle. it is patient and is associated with and We used the of for We 3 litres of oxygen the while the This was associated with as of 100% saturation throughout the procedure, no during and patient ABSTRACT NO.: infusion with for anaesthesia S Bengaluru Summary: In infusion is the The significant of the are the to the infusion in age and with the body mass of model and the to for drugs. The model in can many of The model is developed with a It to a age of to and a weight of to The has been by It also the of The model the and of thus achieve ABSTRACT NO.: A Airway Summary: have for airway management. the of the intubation However, are We have a laryngoscope for endotracheal which is We have used a Macintosh laryngoscope and a for Macintosh laryngoscope is available in operating and the one We have used it for intubation as well as intubation. After in with normal we used it in with difficult patient had a and one had a We used it in paediatric It was to be and in all the patients. This laryngoscope is a boon for airway management. ABSTRACT NO.: the a Rangalakshmi S Rajarajeswari Medical College and Hospital, Bengaluru Summary: with medical and other equipment a significant and and to to and surgeries are It is to their the of anaesthesia by a informed of anaesthetic like regional total and anaesthesia is with and is also the of the us up to our by about in various and to make our operating green and the ABSTRACT NO.: - a and Summary: We present a case of required blood pressure monitoring during surgery. In our are done under with two portable are our and care portable was done when were were performed in the first attempt with in less than under were performed by and with 6 months and years. case required a A portable was not for the ABSTRACT NO.: of Hospital, Summary: The of in emergency cases became in with This was not in the patient’s but later presented as multiple and eye after the induction of general anaesthesia. intubated the so pressure was until by after the surgery. about after was revealed later after ABSTRACT NO.: the intubation is Summary: A difficult whether or can be a for an to a and are being to to difficult is the to the difficult airway cart. It is a of in a It and into tissues in a and which in is by the of a thus a from within the airway so that one can a inside the and glottis. The of is that it the opening, whereas all other thus it from other ABSTRACT NO.: block for in Medical College and Hospital Summary: in about of However, the 1 is in less than of cases. for in this the risk of among block, a plane block, initially for its in studies have the and of local with this block, and from the injection This can and visceral multiple This has led to its in and an injection site from the also avoid associated with neuraxial