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Bhalerao PM, Kuttarmare SM, Joshi S, Naik SV. Perioperative Challenges in the Management of Rhino-Orbital Cerebral Mucormycosis: An Observational Study from a Tertiary Care Hospital. Anesth Essays Res 2022; 16:331-335. [PMID: 36620102 PMCID: PMC9814004 DOI: 10.4103/aer.aer_83_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 12/14/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) pandemic is the biggest threat of the century. Associated with this disease, are a number of rhino orbital cerebral mucormycosis cases seen as post COVID sequelae. Amphotericin B and surgical debridement are the treatment modalities. Aims This study aimed to describe the clinical characteristics and perioperative outcomes of patients with ROCM. Settings and Design This was a prospective, observational study. Materials and Methods We carried out a study of 238 patients with confirmed ROCM posted for functional endoscopic sinus surgery, craniotomies, maxillofacial surgeries, and orbital exenteration under general anesthesia and the perioperative challenges therein. Statistical Analysis Used Data were entered in the excel sheet. Descriptive statistics were used to summarize the data. Analysis was done using the Statistical Package for the Social Sciences (SPSS) version 27:0. Categorical variables were expressed as counts and percentages. Results 78% had diabetes mellitus, 64% had received steroids, 59% had a preoperative oxygen saturation of less than 90%, 86% had a 4-6 zone involvement on chest radiograph, and more than 50% had an anticipated difficult airway. Postsurgery, 13% of patients required intensive care. The 15-day mortality rate was 3% among the operated cases. Conclusion Post-COVID ROCM is challenging in terms of preoperative poor general condition, difficult airway, intraoperative concerns due to pathophysiology of the disease and its effect on organ systems, and the requirement of postoperative vigilant monitoring.
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Affiliation(s)
- Pradnya Milind Bhalerao
- Department of Anaesthesiology, B. J. Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Shital Mahendra Kuttarmare
- Department of Anaesthesiology, B. J. Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Shweta Joshi
- Department of Anaesthesiology, B. J. Medical College and Sassoon General Hospital, Pune, Maharashtra, India
| | - Sanyogita Vijay Naik
- Department of Anaesthesiology, B. J. Medical College and Sassoon General Hospital, Pune, Maharashtra, India
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Mehta M. Abstract No.: ABS0125: Study of airway management in 50 COVID positive patients in ICU. Indian J Anaesth 2022. [PMCID: PMC9116748 DOI: 10.4103/0019-5049.340674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background & Aims: The aim was to successfully perform airway management by securing definite airway via endotracheal tube in emergency or semi- emergency situation in first attempt without causing any trauma to the patient. Methods: In our ICU, tracheal intubation was done for patients with COVID-19 which was based on clinical criteria as per the institute protocol. Intubation was performed by an expert in airway management using method of rapid sequence intubation anddirect laryngoscope. Propofol or etomidate were used as induction agent and succinylcholine or rocuronium as musclerelaxant, according to the patient profile. Intubation box, acrylic face shield and personal protective equipment were also used for safety. Various pathological factors also contribute to difficulty in airway management such as edema and ulceration ofepiglottis and vocal cords. Results: Despite a multitude of technical and pathological factors contributing to difficult airway management,in this study of total 50 patients, 45 patients were intubated successfully in the first attempt, 4 patients were intubated in second attempt and 1 patient was intubated after 3 attempts using bougie with some trauma to the patient. All the intubations were performed using direct laryngoscope and rapid sequence intubation by an expert airway manager. ![]()
Conclusion: Therefore, to conclude, in the majority of the COVID 19 ICU patients, airway management was done successfully in the first attempt in emergency situation by the expert airway manager.
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Chhanwal H, Vijayanand S, Kheskani D, Natrajan P. A multicentric prospective study on clear plastic drape versus acrylic box during airway management of COVID-19 patients. Indian J Anaesth 2022; 66:602-606. [PMID: 36274802 PMCID: PMC9580595 DOI: 10.4103/ija.ija_57_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 01/25/2023] Open
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Rastogi A, Agarwal A, Singh T, Priya V. Deployment of anaesthesia technicians in the second wave of COVID- 19 at level 3 centres: A novel initiative. Indian J Anaesth 2021; 65:S180-S181. [PMID: 34908573 PMCID: PMC8613474 DOI: 10.4103/ija.ija_493_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/05/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Amit Rastogi
- Department of Anaesthesiology, SGPGI Lucknow, Uttar Pradesh, India
| | - Anil Agarwal
- Department of Anaesthesiology, SGPGI Lucknow, Uttar Pradesh, India
| | - Tapas Singh
- Department of Anaesthesiology, SGPGI Lucknow, Uttar Pradesh, India
| | - Vansh Priya
- Department of Anaesthesiology, SGPGI Lucknow, Uttar Pradesh, India
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George LR, George SE, Dhawan I, Babu M, Sahajanandan R, Joselyn AS. Simulation with a colour indicator to help reduce contamination during airway management in COVID-19 times: An experience from a tertiary centre in India. Indian J Anaesth 2021; 65:820-829. [PMID: 35001955 PMCID: PMC8680416 DOI: 10.4103/ija.ija_768_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND AIMS The coronavirus disease 2019 (COVID-19) pandemic has initiated modified protocols for aerosol-generating procedures. A simulation study using dye was conducted to highlight contamination at intubation and extubation and to encourage adherence to the new COVID-19 protocol among anaesthesia personnel in our institution. METHODS A video demonstrating the new COVID-19 protocols was circulated in the Department of Anaesthesiology a week prior to the study. Thirty teams, each comprising an anaesthesia resident and a staff technician, were enroled. Each team was asked to demonstrate the steps of preparation, intubation and extubation on a mannequin in a COVID-19 scenario. Checklists were used to assess points of contamination and adherence to the protocols. Following debriefing, a repeat simulation was conducted. The use of a dye highlighted the points of contamination. The study subjects provided feedback on the usefulness of the session and practical difficulties encountered in adapting to the new protocols. RESULTS The average contamination scores decreased by 3.4 (95% confidence interval (CI): 2.4-4.4, P < 0.001) in the post-debrief session. Adherence to the steps of the modified protocol improved by a score of 2.7 (CI: 3.6-1.83) among anaesthesiologists and by 4.3 (CI: 5.3-3.3) among technicians. Further, 93% felt that the use of the colour indicator reinforced awareness of the possible points of contamination. CONCLUSION Simulation with a low-fidelity mannequin by using colour indicator for secretions is an effective teaching tool to reduce health hazards during airway management in COVID-19 times.
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Affiliation(s)
- Leah R. George
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Smitha E. George
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Ira Dhawan
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Malavika Babu
- Department of Biostatistics, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Raj Sahajanandan
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Anita S. Joselyn
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Hooli SA, Gadre VN, Bage S, Gilvarkar MD. The aftermath of COVID-19 pandemic: Rhino-orbital mucormycosis. Indian J Anaesth 2021; 65:548-553. [PMID: 34321687 PMCID: PMC8312397 DOI: 10.4103/ija.ija_371_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/05/2021] [Accepted: 06/05/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Suhas Ashok Hooli
- Department of Anaesthesiology, Grant GMC, Mumbai, Maharashtra, India
| | | | - Sunita Bage
- Department of Ear Nose Throat, Grant GMC, Mumbai, Maharashtra, India
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Wagh HD. Prevention of aerosolisation during a tracheostomy. Indian J Anaesth 2021; 65:490-492. [PMID: 34248196 PMCID: PMC8253005 DOI: 10.4103/ija.ija_94_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/04/2021] [Accepted: 05/08/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- Harshal D Wagh
- Department of Anaesthesia, Kokilaben Ambani Hospital, AchutRao Patwardhan Marg, Andheri West, Mumbai, Maharashtra, India
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Mehdiratta L, Bajwa SJS, Kurdi MS, Bhattacharya PK. Research in COVID times-Innovations, revolutions and contentions. Indian J Anaesth 2021; 65:277-281. [PMID: 34103740 PMCID: PMC8174599 DOI: 10.4103/ija.ija_285_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Lalit Mehdiratta
- Department of Anaesthesiology, Critical Care and Emergency Medicine, Narmada Trauma Centre, Bhopal, Madhya Pradesh, India
| | - Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Patiala, Punjab, India
| | - Madhuri S Kurdi
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences (KIMS), Hubli, Karnataka, India
| | - Pradip Kumar Bhattacharya
- Department of Critical Care Medicine, New Trauma and Emergency Centre, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India
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Optimizing Airway Surgery in COVID 19 Era. Indian J Otolaryngol Head Neck Surg 2021; 74:3370-3377. [PMID: 33432295 PMCID: PMC7788273 DOI: 10.1007/s12070-020-02326-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/14/2020] [Indexed: 12/30/2022] Open
Abstract
Otorhinolaryngologists, particularly dealing with airway cases, are subjected to highest risk of COVID 19 aerosolisation, self infection and transmission. Moreover, airway cases, which mostly present as emergency, cannot be deferred. Being a tertiary airway centre and having received a number of airway cases, most of them requiring prompt surgical intervention, our airway surgery and anaesthesiology team had to work in conjunction to adapt and readapt the practice over the past few months, striving to achieve effective airway surgery protocols, to minimize exposure and prevent transmission of COVID 19. To enlist the encountered airway cases during COVID 19 pandemic and to highlight the important inclusions and adaptations in executing the airway surgeries. A retrospective observational study of 7 months duration was carried out. This is a single institutional study, where the sample included the primary as well the referred airway cases. Apart from Tracheotomy, Foreign body bronchus removal, Dilatation of Laryngotracheal Stenosis (LTS) and excision of Recurrent Respiratory Papillomatosis (RRP), we also have had the experience to deal with congenital Laryngo-tracheo-oesophageal Cleft (LTOC) Type III b, Thyroid surgery to relieve tracheal compression and Bilateral Choanal Atresia repair during the last 7 months. Routine 2 weeks follow up of the patients have been favourable, as there has not been any report or clinical features of transmission of COVID 19. As the airway surgeries could be executed with the incorporation of certain change in practice and as the follow up revealed no evidence of transmission, we attempt to contribute to airway best practice guideline for maintaining the safety of patients and health professionals.
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Vidhya S, Prakash N, Swain A, Kumar S, Shukla R. An inquiry on airway management by mccoy blade with elevated tip and miller straight blade with paraglossal technique: Relevance for difficult airway management in current infectious times. Anesth Essays Res 2021; 15:401-407. [PMID: 35422547 PMCID: PMC9004280 DOI: 10.4103/aer.aer_163_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Aim: Materials and Methods: Results: Conclusion:
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Raveendra US, Gupta A, Biswas S, Gupta N. Coping with airway emergencies: Get, Set, Go! Indian J Anaesth 2020; 64:S168-S174. [PMID: 33162597 PMCID: PMC7641048 DOI: 10.4103/ija.ija_591_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/22/2020] [Accepted: 08/02/2020] [Indexed: 11/04/2022] Open
Abstract
Airway emergencies are among the life-threatening events that are encountered in the operating room, emergency department or intensive care unit. They are important causes of preventable morbidity and mortality where time is the essence. It can be extremely challenging to rapidly assess the airway for early diagnosis and perform appropriate interventions simultaneously. Outcome depends on the implementation of an optimal strategy to establish a patent airway. Equally important is the overall stabilisation of the patient and management of the primary clinical condition as appropriate. Key components of management include early recognition of threatened airway, appropriate and timely airway intervention, and maintaining oxygenation. In this review, we describe aetiology, evaluation and management of airway emergencies.
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Affiliation(s)
- U S Raveendra
- Department of Anesthesia, Jerudong Park Medical Centre, Brunei, Darussalam
| | - Anju Gupta
- Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS, Delhi, India
| | - Swagata Biswas
- Department of Onco-Anesthesiology and Palliative Care, AIIMS, Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anesthesiology and Palliative Care, AIIMS, Delhi, India
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Bhatnagar S, Mehdiratta L, Karthik AR. Corona pandemic: Bringing Anaesthesiologist's professional role and other skills to the fore. Indian J Anaesth 2020; 64:S87-S90. [PMID: 32773844 PMCID: PMC7293376 DOI: 10.4103/ija.ija_579_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, IRCH, New Delhi, India
| | - Lalit Mehdiratta
- Department of Anaesthesiology, Critical Care and Emergency Medicine, Narmada Trauma Center, Bhopal, Madhya Pradesh, India. E-mail:
| | - A R Karthik
- Department of Onco-Anaesthesia and Palliative Medicine, DR. BRAIRCH, AIIMS, New Delhi, India
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