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Accuracy of Modified Mallampati Test over Other Parameters for Preoperative Prediction of Difficult Endotracheal Intubation
Venkateshamurthy Banavara Champa,
Venkappa Yashoda,
Nagarajarao Karnalli Gurudutta
Issue:
Volume 8, Issue 1, June 2020
Pages:
1-5
Received:
19 August 2019
Accepted:
12 November 2019
Published:
19 February 2020
DOI:
10.11648/j.ijacm.20200801.11
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Abstract: Difficult airway remains a potential problem for practicing anaesthesiologists. Modified mallampati test alone has low sensitivity and specificity. Preoperative assessment of the airway using a combination of simple tests will increase the sensitivity and specificity of prediction of difficult airway than using a single parameter alone. This study was done to compare the sensitivity, specificity and accuracy for preoperative prediction of difficult endotracheal intubation in adults undergoing elective surgeries using combination of Modified Mallampati test [MMT], Sternomental distance [SMD], Thyromental distance [TMD] and Neck mobility [NM] over MMT alone and to assess whether MMT alone or in combination with TMD, SMD and NM is a better predictor of difficult laryngoscopy. This is a prospective observational study. 100 patients undergoing elective surgeries under general anaesthesia were enrolled into two groups. Group 1 was the MMT group and Group 2 was the MMT, TMD, SMD & NM Group. Results were analysed using SPSS software Version 12 and STATA used for analysing the sensitivity, specificity, PPV, NPV and accuracy in each group. P value calculated using Chi Square test. Group 1 had lower sensitivity, specificity, PPV, NPV as well as Accuracy when compared with that of Group 2. The combination of the parameters yielded a greater accuracy in predicting the difficult intubation stressing the importance of assessing the evaluation of other parameters like TMD, SMD & NM along with MMD for successful prediction of a difficult endotracheal intubation. In conclusion the MMT alone in preoperative assessment of difficult laryngoscopy is less sensitive. The combination of MMT, TMD, SMD & NM is more sensitive as well as specific to predict a difficult intubation than using MMT alone in the pre-operative period.
Abstract: Difficult airway remains a potential problem for practicing anaesthesiologists. Modified mallampati test alone has low sensitivity and specificity. Preoperative assessment of the airway using a combination of simple tests will increase the sensitivity and specificity of prediction of difficult airway than using a single parameter alone. This study ...
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Comparison Between Ultrasound- and Bronchoscopy-guided Percutaneous Dilational Tracheostomy in Critically Ill Patients
Hongding Lin,
Xiaoyan Lin,
Renhui Chen,
Weiting Chen
Issue:
Volume 8, Issue 1, June 2020
Pages:
6-10
Received:
9 February 2020
Accepted:
20 February 2020
Published:
2 March 2020
DOI:
10.11648/j.ijacm.20200801.12
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Abstract: To compare the clinical efficacy, safety, and prognosis between fiberoptic bronchoscopy-assisted percutaneous dilatation tracheostomy and real-time ultrasound-guided percutaneous dilatation tracheostomy, and evaluate their clinical application value for further clinical use. From January, 1, 2018, to November 1, 2019, 64 newly admitted patients in our hospital undergoing percutaneous dilatation tracheostomy were included in the study. They were divided into two groups, the random fiber bronchoscopy-assisted percutaneous dilatation tracheostomy group (control group) and the modified bedside ultrasound-guided percutaneous dilatation tracheostomy group (study group), according to the random number table method, with 32 patients in each group. Subsequently, the intraoperative and postoperative complications and clinical prognostic indicators of the two groups were compared. There were statistically significant differences between the two groups in the number of punctures, puncture time, and incidence of air sac leakage (P<0.05); however, the number of punctures and the incidence of air sac leakage were lower in the study group than in the control group. There was no statistically significant difference between the two groups in the postoperative transient hypotension, transient acute hypoxia, atelectasis, infection, and excessive phlegm at the surgical incision, subcutaneous emphysema, and other complications (P>0.05). Real-time ultrasound-guided percutaneous dilatation tracheostomy can reduce the number of punctures in the air sac with no further complications and clinical prognosis.
Abstract: To compare the clinical efficacy, safety, and prognosis between fiberoptic bronchoscopy-assisted percutaneous dilatation tracheostomy and real-time ultrasound-guided percutaneous dilatation tracheostomy, and evaluate their clinical application value for further clinical use. From January, 1, 2018, to November 1, 2019, 64 newly admitted patients in ...
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About a Case, Macrophagic Activation Syndrome Post Vaccination
Zakaria Abjaw,
Reda El Hadrami,
Houssam Eddine Sahraoui,
Hamza El Hamzaoui,
Taoufik Abouelhassan,
Ghita Beddou,
Hicham Yahyaoui,
Imane Benjelloun,
Mustapha Ait Ameur,
Mohamed Chakour
Issue:
Volume 8, Issue 1, June 2020
Pages:
11-13
Received:
26 January 2020
Accepted:
14 February 2020
Published:
17 March 2020
DOI:
10.11648/j.ijacm.20200801.13
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Abstract: Introduction: Macrophage activation syndrome (SAM) results from inappropriate activation of macrophages in the bone marrow and lymphoid organs, responsible for hemaphagocytosis. It is a clinicopathological entity characterized by an excessive and uncontrolled inflammatory response that can be life-threatening. We report the case of macrophage activation syndrome complicating pleuropulmonary tuberculosis. Observation: this is the case of a 36-year-old patient, with antimalarial vaccination against malaria for a trip to the endemic area, who presents himself 4 days after his vaccination, in a table of asthenia and NYHA stage III dyspnea. the clinical examination found a conscious patient GCS 15/15, generally impaired, tachycardia at 125bpm, hypotensive at 85 / 32 mmHg, tachypneic at 36 cpm, with SpO2 at 87% in the open air, biologically: normal normocytic anemia at 8.4 g / dl, thrombocytopenia at 26000 / ul, leukocytosis at 34350 / ul, hyponatraemia at 123 mmol / l, hyperkalaemia at 6.26 mmol / l, uremia: 2.1g / l, cratininemia: 54 mg / l, Hepatic cytolysis with ASAT 3 times normal and ALAT 4 times normal, management consisted in admission to intensive care unit evolution was pejorative within the 24 hours of admission, by the installation of a state of refractory septic shock, The post-mortem myelogram confirmed macrophage activation. Discussion: The incidence of SAM is poorly known and its frequency is underestimated. A rare disease, the diagnosis of which is often delayed, especially in rapidly developing patients. The diagnosis remains an emergency for the care that remains non-consensual. Conclusion: SAM is a rare and poorly described clinical situation but unfortunately a source of wandering and delayed diagnosis. Rare, severe and often unrecognized can compromise life expectancy. The aim of the treatment is to control the macrophage reaction.
Abstract: Introduction: Macrophage activation syndrome (SAM) results from inappropriate activation of macrophages in the bone marrow and lymphoid organs, responsible for hemaphagocytosis. It is a clinicopathological entity characterized by an excessive and uncontrolled inflammatory response that can be life-threatening. We report the case of macrophage activ...
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Treatment of Postoperative Sore Throat with Ultrasound-guided Internal Branch of Superior Laryngeal Nerve Block: A Report of Three Cases
Meirong Wang,
Zhipeng Li,
Huibi Ouyang,
Chuiliang Liu
Issue:
Volume 8, Issue 1, June 2020
Pages:
14-17
Received:
13 February 2020
Accepted:
25 February 2020
Published:
17 March 2020
DOI:
10.11648/j.ijacm.20200801.14
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Abstract: Background Postoperative sore throat (POST) is a common problem following extubation after general anesthesia (GA). Severe POST leads to dissatisfaction and discomfort for a longer period, are resistant to current medical treatment. Method POST was measured after extubation 30 min, 2 h, 4 h, 6 h and 24 h. We present three cases of severe hoarseness or aphonia after extubation. A 8–13 MHz high frequency linear probe ultrasound transducer was used to visualize the internal branch of superior laryngeal nerve block (ibSLNB), which through thyrohyoid membrane between hyoid bone and thyroid cartilage. By out-plane technique, 2 mL of 2% lidocaine was injected around ibSLNB on each side. Result The three cases with severe POST was successfully treated with ultrasound-guided bilateral ibSLNB within 5 min, and their voice rapidly became louder and clearer. POST was significantly disappeared for 2-4 hours, and subsequently the resurfaced throat pain was milder, only needed or no anti-inflammatory drugs. No choking or aspiration was observed after ibSLNB when they were asked to swallow 20 ml of liquid 2 h post-operation. No postoperative laryngospasm or vomiting were recorded. Conclusion The ultrasound-guided bilateral ibSLNB may be a valid alternative to drugs, especially in serious acute POST after extubation.
Abstract: Background Postoperative sore throat (POST) is a common problem following extubation after general anesthesia (GA). Severe POST leads to dissatisfaction and discomfort for a longer period, are resistant to current medical treatment. Method POST was measured after extubation 30 min, 2 h, 4 h, 6 h and 24 h. We present three cases of severe hoarseness...
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Optimizing Institutional Care of Implantable Intrathecal Drug Delivery Systems
Angela Kerins,
Randall Knoebel,
David Dickerson,
Magdalena Anitescu
Issue:
Volume 8, Issue 1, June 2020
Pages:
18-25
Received:
21 February 2020
Accepted:
13 March 2020
Published:
31 March 2020
DOI:
10.11648/j.ijacm.20200801.15
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Abstract: Intrathecal drug delivery systems (IDDS) have been a valuable therapeutic modality in the treatment of intractable chronic pain, typically reserved for cases where conservative pain management has failed. Given the high risk of this treatment and infrequent encounters with IDDS, it is essential to develop an institutional process to ensure the safe and effective management of patients. Our multidisciplinary team utilized healthcare failure mode and effects analysis (HFMEA™) to identify risks and redundancies in our current processes, subsequently implementing changes to prevent them. Risks identified included: handwritten orders, no standard order set, manual drug calculations, poor identification of IDDS upon hospital admission, and scarce nursing documentation of intrathecal medication. Following this step, our team incorporated tools and technologies to manage the more complex IDDS patients: standard order sets, computerized physician order entry (CPOE) systems, and computerized clinical decision support (CCDS) systems. Also, an excel calculator was introduced—seemingly the first of its kind in clinical practice—thus making the process more unique, thorough, and safe. There is a large body of evidence supporting the use of computerized physician order entry systems (CPOE) to reduce medication errors, and providing access to a computerized clinical decision support system (CDDS) at the time of prescribing to improve outcomes in patient care. Incorporating these tools into the management of IDDS patients is a significant opportunity to reduce risks and improve patient outcomes.
Abstract: Intrathecal drug delivery systems (IDDS) have been a valuable therapeutic modality in the treatment of intractable chronic pain, typically reserved for cases where conservative pain management has failed. Given the high risk of this treatment and infrequent encounters with IDDS, it is essential to develop an institutional process to ensure the safe...
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Acute Myelitis After Correction of Hypospadias with Caudal Anesthesia
Jeniffer Almeida Correa do Nascimento,
Matheus de Castro Abi-Ramia Chimelli,
Jose Eduardo Smilgevicius Silva,
Marcelo Grisolia Gonçalo,
Pedro Paulo Vanzillota
Issue:
Volume 8, Issue 1, June 2020
Pages:
26-29
Received:
14 February 2020
Accepted:
4 March 2020
Published:
23 April 2020
DOI:
10.11648/j.ijacm.20200801.16
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Abstract: Combined epidural anesthesia with general anesthesia is the preferred anesthetic technique for lower limb surgery as well as lower abdominal, genitourinary and perineal surgery in children. This case report below depicts a rare complication: acute myelitis. It occurred following surgical correction of hypospadias (first stage) under combined caudal epidural anesthesia with general anesthesia in an Eight-months-old infant, weighing 9.8 kilograms, with no surgical/anesthetic history, without known allergies, previously healthy, with adequate developmental milestones, physical examination without abnormalities, without difficult airway predictors, with adequate fasting time and normal laboratorial exams. Some etiologies for this case report have been suggested such as spinal cord trauma, infectious and vascular causes, local anesthetic and noxious chemicals neurotoxicity and demyelinating diseases. In spite of thorough scrutiny, we were not able to define a single cause for the clinical manifestations. In this setting, the treatment goal was to provide support measures and rehabilitation of neurological deficits.
Abstract: Combined epidural anesthesia with general anesthesia is the preferred anesthetic technique for lower limb surgery as well as lower abdominal, genitourinary and perineal surgery in children. This case report below depicts a rare complication: acute myelitis. It occurred following surgical correction of hypospadias (first stage) under combined caudal...
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