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João Abrão, Antoine Louis Jacques M, Álvaro Dowling and Kai-Uwe Lewandrowski*

DOI : 10.32474/GJAPM.2020.03.000174

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Background: Providing adequate anesthesia that caters to rapid turn-over in an outpatient ambulatory surgery center setting is sometimes as much of an art as it is a science. Outpatient spine surgery is characterized by shorter simplified versions of their inpatient counterparts carried out in a hospital setting. Objective: The monitored anesthesia care (MAC) and deep sedation with a laryngeal mask airway (LMA) in the prone position have received little attention in the anesthesia and spine surgery literature. The authors reviewed their clinical outcomes with the outpatient endoscopic spinal surgery in conjunction with these two types of anesthesias. Methods: We performed an analysis of perioperative anesthesia and clinical outcomes in 184 patients who underwent lumbar endoscopic spinal surgery in two outpatient ambulatory surgery ..... ReadMore

Kelvin Wang BSE, Krishna B Shah and Suman Rajagopalan*

DOI : 10.32474/GJAPM.2020.03.000173

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Airway management of a patient with penetrating facial trauma is often anticipated to be difficult. However, due to the variation in presentation of penetrating facial trauma, there are no consensus guidelines established for securing the airway. We present a case of penetrating facial trauma with an impaled screwdriver, describe the anatomical significance of the embedded foreign object, and suggest an approach to airway management. Ultimately, a skilled provider must use his or her clinical judgement and have a clear understanding of anatomy to best approach these unique scenarios..... ReadMore

Polukhov RSh, Nasibova EM*, Polukhova AE, Rustamkhanly AM, Sultanova MJ and Nasibov FG

DOI : 10.32474/GJAPM.2020.03.000172

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The novel coronavirus infection (COVID-19) pandemic, caused by the highly contagious severe acute respiratory syndrome coronavirus (SARS-CoV-2), is still at its peak, causing thousands of deaths every week. Since the beginning of the coronavirus (just a few months ago), our understanding of the disease has grown rapidly. While there are several large, randomized drug trials currently underway, current survival from severe COVID-19 is entirely dependent on providing the best supportive care possible...... ReadMore

Metin Tas and Ayse Veyhurda Dikmen*

DOI : 10.32474/GJAPM.2020.03.000171

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A 71 year-old male patient, who was diabetic and hypotensive, was admitted to emergency room with the complaints of high fewer, shortness of breath and general malaise. He was diagnosed to have acute renal failure, signs of uro-sepsis and emphysematous pyelonephritis with pathognomonic computerized tomography (CT) scans. After 7 days of follow-up with meropenem and teicoplanin treatment and hemodialysis, the patient was externed. This case was an emergent case of emphysematous pyelonephritis, which is a rare entity with a high incidence of mortality in modern clinical practice...... ReadMore

Azza Ahmed Ameen Hafez*

DOI : 10.32474/GJAPM.2020.03.000170

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Fluid therapy is an essential component part management of critically ill patients. Proper estimation of the amount of needed fluids is of great importance due to the well-established adverse effects of marked negative and positive fluids balance. Central venous pressure has been widely used by ICU physicians for volume status assessment. Several methods have been postulated for volume status assessment, among which is the inferior vena cava collapsibility index. As the inferior vena cava is a thin-walled capacitance vessel that adjusts to the body’s volume status by changing its diameter depending on the total body fluid volume. Giving the fact that bedside ultrasonographic measurement of inferior vena cava diameters is an available, non-invasive, reproducible, and quiet easy-to-learn technique, it can provide a safe and quiet re..... ReadMore

Behzad Saberi*

DOI : 10.32474/GJAPM.2020.03.000169

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There are common abnormalities which can be seen due to occlusion in the anterior or posterior circulation of the brain in the Cerebrovascular accident which can be helpful to localize the lesion at the bedside Aphasia, Amaurosis fugax, Hemisensory loss, Hemianopic visual loss and Hemiparesis are common abnormalities which can be seen in the occlusion of the anterior circulation which would be the territory of the carotid and comprise about 80 percent of the cases Hemianopic visual loss, Syncope, Tetra paresis, Transient global amnesia, Ataxia, Diplopia, Dysarthria, Chocking, Hemisensory loss, Vertigo and Vomiting are common abnormalities which can be seen in the occlusion of the posterior circulation which would be the territory of the vertebrobasilar and comprise about 20 percent of the cases...... ReadMore

Shiv Charan Navriya*, Satish Kumar Ranjan, Sunil Kumar, Ashwani Kumar Kandari, Tushar Aditya Narain and Kim Jacob Mammen

DOI : 10.32474/GJAPM.2020.03.000168

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COVID-19 disease was first reported in Wuhan city of China, since then this is spreading with alarming speed and had already affected more than 213 countries around the world. The COVID-19 pandemic has had a global impact on all sectors of public health and hospital services. Naturally, urology services have been affected too with several patients, suffering from urological malignancies and renal stone disease, left to their fate. Present records hint towards this pandemic continuing at least till the end of this year and it is only prudent that we come up with strategies to re-initiate urological services in a phased and a safe manner to tackle both, the urological diseases and the COVID-19 infection. This review aims at providing recommendations for resumption of urological services in a phased manner, based on the available evide..... ReadMore

Mohit Kumar, Bhavna Gupta* and Suresh Kumar

DOI : 10.32474/GJAPM.2020.03.000167

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A 15 year old American Society of Anaesthesiologist class 1 male, was, posted for modified radical mastoidectomy under general anaesthesia. On the day of the surgery, routine standard monitors were attached. The ECG on the monitor showed normal sinus rhythm with a heart rate of 88/min, blood pressure of 100/70 mmHg, peripheral saturation of 99% on room air.He was pre-medicated with 1mg intravenous Midazolam, 80 micrograms fentanyl and induced with 100 mg propofol and vecuronium 5 mg.Trachea was intubated with 6 mmID cuffed endotracheal tube and connected to anaesthesia workstation. Anaesthesia was maintained on 50:50 O2 :N2 O and Sevoflurane...... ReadMore

Uzma Afreen and Krishna Shailaja A*

DOI : 10.32474/GJAPM.2020.03.000166

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Novel drug delivery attempts to either sustain drug action at a predetermined rate, or by maintaining a relatively constant, effective drug level in the body with concomitant reduction of undesirable side effects. In vesicular drug delivery system drug binds covalently to the lipid molecule by which the drug release in a controlled manner and also drugs which are of hydrophilic or lipophilic nature can be delivered by using the vesicular drug delivery systems. The release of drug from the vesicles depends on the physicochemical characteristic of both the drug and carrier. Vesicular drug delivery system contains liposomes, niososmes, transferosomes, pharmacosomes, emulsomes, electrosomes, ethosomes etc. Pharmacosomes are amphiphilic phospholipids complexes of drugs bearing active hydrogen that bind to phospholipids. Like further vesi..... ReadMore

Bikash Khadka*

DOI : 10.32474/GJAPM.2020.03.000165

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otherwise useful agent such as propofol for short cases and day care surgeries. Lidocaine and ketamine both are used as pretreatment to decrease propofol related injection pain. The aim of this study is to compare effectiveness of ketamine injection to decrease propofol induced pain in comparison to lidocaine injection. Method: This is a cross sectional comparative study. 89 cases were divided into two groups where group K received ketamine 2 ml (0.2 mg/kg) whereas group L received lidocaine 2% 2ml (0.5 mg/kg) as pre-treatment medication after venous occlusion with rubber tourniquet. 1/4th dose of propofol was injected 1 min after release of tourniquet and pain accessed at 0, 1 and 2 minutes of propofol injection with verbal response and behavioural signs. Chi square test and paired T test was used and p value less than 0.05 was con..... ReadMore

Rajeev Nair and Satish Kumar Mishra*

DOI : 10.32474/GJAPM.2020.03.000164

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Bleeding is a frequent complication during surgery. The intraoperative administration of blood products, including packed red blood cells, platelets, and fresh frozen plasma (FFP), is often lifesaving. Complications of blood transfusions contribute considerably to perioperative costs and blood product resources are limited. The aim of the present study was to evaluate and compare the usage of INR guided vis a vis clinician discretion based component replacement therapy which will optimize the use of FFP and may even result in less blood loss during surgery. Materials and Method: This study was conducted in surgical patients in a large tertiary care centre. Ethical clearance was taken from the local ethics committee at the proposal stage itself. Patients consent was taken after providing all necessary information prior to surgery. Th..... ReadMore

Kalpana Rajendra Kulkarni* and Rajendra Madhukar Kulkarni

DOI : 10.32474/GJAPM.2020.03.000163

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Background: Peripheral vascular diseases (PVDs) associated with atherosclerosis, hypertension, diabetes, thromboembolism, chronic regional pain syndrome or Berger’s disease, presents with ischemic manifestations of cold limbs, claudication, ulcers, or gangrene. Chemical lumbar sympathetic block (LSGB) with alcohol/ phenol and radiofrequency ablation (RF) are well-established methods to improve the circulation. Methods: We conducted prospective observational study in 150 cases of PVDs who underwent chemical LSGB using 5ml of phenol 8% at two levels L2 and L3 under guidance of fluoroscopy (Group CH, n=50), RF ablation of lumbar sympathetic ganglions at L2 and L3 level (Group RF, n=50) and combined RF with chemical LSGB using phenol 5ml 8% at L2and L3level following RF(Group RF+CH, n=50). Results: There was significant difference i..... ReadMore

Tong Zheng Hong*

DOI : 10.32474/GJAPM.2020.03.000162

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This unique and newly developed acupoint protocol composed of Yuan-Source and Luo-Connecting acupoints was conducted to the patient with thalassemia for knee pain. Therapeutic effects of acupuncture for the knee pain were observed and rated by the patient on the Wong-Baker Faces Pain Scale from 6 to 2 with the first treatment, the pain did not reoccur, and the patient could fall asleep easily and soundly, which shows this protocol is effective to reduce the pain and deserve attention..... ReadMore

Nasibova EM*

DOI : 10.32474/GJAPM.2020.03.000161

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Propofol (diprivan) is the drug of choice in one-day surgery in children. The use of the drug provides rapid awakening (due to rapid redistribution and short half-life) and a minimum incidence of postoperative complications. Total intravenous anesthesia with propofol infusion or bolus administration is an easily managed anesthesiologist, anesthesia comfortable for the patient..... ReadMore

Bikash Khadka* and Prajjwal Raj Bhattarai

DOI : 10.32474/GJAPM.2020.03.000160

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Background: Continuous spinal anaesthesia (CSA) is an underutilized technique in modern aesthesia. It allows incremental intermittent dosing of an intrathecal local anaesthetic via an intrathecal catheter which allows titration of block level, block of indefinite duration and better hemodynamic stability than single-shot spinal anaesthesia (SSA)...... ReadMore

Nasibova EM* and Pashaev CN

DOI : 10.32474/GJAPM.2020.03.000159

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Decades have passed since the first reports of the successful use of mask non-invasive ventilation (NIV) in the treatment of respiratory failure. The aim of the study is determining the benefits of NIV in acute respiratory failure in patients with COVID-19. The study included patients admitted to the intensive care unit of the surgical clinic of the AMU from April 1 to May 1, 2020. NIV has visible advantages over mechanical ventilation. But it must be remembered that even in experienced hands, NIV is successful only in 75-90% of all cases, which depends on many factors, such as the severity of ONE, the training and experience of medical personnel. As with many types of therapy, operations, and technologies, improvement in the results of this method can be expected as experience is gained. High minute lung ventilation (>10 L/min) dur..... ReadMore

Cassandra Gerhart*

DOI : 10.32474/GJAPM.2020.03.000158

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Review Topic: Use of Regional Anesthesia in Patients with Multiple Sclerosis Background: This article will focus on patients who have traditionally been considered contraindicated for the use of regional anesthesia. Specifically, patients with autoimmune mediated neurologic disorders. The selected pathophysiology of multiple sclerosis and regional anesthesia and their considerations via evaluation of research studies will be presented. Furthermore, suggestions for anesthesia care for these patients will be provided. Project Aim: The purpose of this article is to and educate anesthesia providers on patients with multiple sclerosis and anesthesia implications for this population. There appears to be a lack of discussion and research in the United States regarding the use of regional anesthesia in these patients. After reading this ar..... ReadMore

Joanne Lusher*, Alexandra Murrell, Betty Changa, Christopher Mafuva, Eddy Awire and David Chapman Jones

DOI : 10.32474/GJAPM.2020.03.000157

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Pain is a subjective experience and one that the medical healthcare profession will never fully be able to understand because the pain belongs to the patient. Ultimately, pain is whatever the patient experiences it to be, yet the traditional medical model approach is one that views the patient’s pain as something to be managed by the ‘professional’ [1,2]...... ReadMore

Zaily Fuentes Díaz*, Gonzalo Fabián Orga García, Orlando Rodríguez Salazar, Jorge Lozano Casanova, Tania Puerto Pérez5

DOI : 10.32474/GJAPM.2020.03.000156

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Introduction: the physiological response to the aggression produced by the surgical trauma provides the effective treatment capacity in case of complications. Surgical intervention causes endocrine, metabolic, autonomic, immunological, and hematological changes...... ReadMore

Yasser Mohammed Hassanain Elsayed*

DOI : 10.32474/GJAPM.2020.03.000155

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Background: Arrhythmias are one of the most serious disorders in cardiovascular and clinical medicine. Understanding the pathogenesis and mechanisms of arrhythmias is very advantageous to the appropriate management and treatment of all arrhythmia types. The “Graded phenomenon” is a novel directory phenomenon for understanding the arrhythmia. The principal of “Graded phenomenon” is based on catching the graded changes in serial ECG tracings or even single one regarding the arrhythmias...... ReadMore