Organ donation is becoming more common but there is still a large gap between the number of people requiring transplants and the organs donated. There are set criteria for organ donation. When organ donation is considered after brain death, the physician must ensure that the prerequisites for testing are met and proceed to establish brain death using standard guidelines. The pathophysiological changes that occur after brain death must be borne in mind and utmost care should be given to counter those changes that would result in dysfunction of the donated organs. The brain dead patient must be maintained as stable as possible in the ICU. General nursing and medical care must continue. Core temperature must be maintained and infections must be treated. Blood pressure is best maintained with fluids and minimal vasopressors. Low tidal volume ventilation, optimal levels of positive end-expiratory pressures to maintain minimal FIO2, will maintain airways open and reduce extravascular lung water. Maintain euvolaemia. Maintain urine output at 0.5–3 ml/kg/h. Electrolyte abnormalities must be corrected. Maintain blood glucose concentrations between 120-180 mg %. Triple hormonal therapy improves organ function. Organ retrieval is performed in an operation theatre and a well conducted anaesthetic care is essential for the viability of these organs. One brain-dead organ donor can potentially donate ‘lives’ to eight individuals. To enhance or preserve the maximum potential of the donated organs, the anaesthesiologist and intensivist play a vital role in preserving the organs as best as possible.
Umesh Kumar Bylappa,
Sujith M Prabhakaran,
Adaptive support ventilation (ASV) is a dual control mode of ventilation, which uses a closed loop control technique. This mode delivers controlled, time triggered and time cycled breaths when a patient is not breathing. If the patient has spontaneous breaths, it delivers flow cycled breaths and allows the patient to trigger and breathe spontaneously, either in between the controlled breaths or fully spontaneously. This mode is pressure limited for control, assist control and spontaneous breath. The pressure will vary depending on the target tidal volume and uses autoflow throughout the cycle. IntelliVent(R) is a closed loop mode of ventilation, an advance over the ASV mode where the ventilator automatically adjusts settings and optimises ventilation depending on the target settings and physiological information from the patient.
Background: Obstructive sleep apnoea (OSA) is a breathing disorder during sleep which leads to life-threatening events. The recommended treatment for moderate to severe OSA is continuous positive pressure therapy (CPAP).
Aim: To predict the optimal CPAP level in OSA.
Methodology: This was a cross sectional observational study, carried out in pulmonary medicine department at a tertiary referral centre in South India. Twenty patients were recruited in the study over a period of 6 months. All patients in study group underwent CPAP titration with optimal or good titration over a full night polysomnography.
Results: We correlated the optimal CPAP level with demographic, anthropometric and polysomnographic variables, which showed a trend of association between body mass index (BMI), neck circumference, apnoea hypopnoea index (AHI), oxygen desaturation index (ODI) and severity of OSA with optimal CPAP level
Conclusion: No statistically significant association was observed between demographic, clinical, anthropometric and polysomnographic variables with optimal CPAP level.
Introduction: Vocal cord assessment after thyroidectomy, routinely performed by anaesthesiologist by direct laryngoscopy in the immediate postoperative period is associated with significant haemodynamic changes and patient discomfort.
Aim: Comparison of patient comfort, haemodynamic response and accuracy of assessment of vocal cord mobility between Airtraq and Macintosh laryngoscope.
Methodology: In a prospective, randomised controlled study, 82 euthyroid patients, ASA PS 1-2, aged 20-60 years, of either gender undergoing thyroidectomy under general anaesthesia were randomised to one of two groups, Group M and Group A. Anaesthesia was induced with propofol and fentanyl, maintained with morphine, vecuronium, nitrous oxide and isoflurane in oxygen to maintain a MAC of 1-1.3%. At the end of surgery, patients were extubated after complete reversal of neuromuscular blockade and when fully awake. Vocal cord movement and haemodynamic changes were assessed three minutes later using either Airtraq (Group A) or Macintosh laryngoscope (Group M). Patient reactivity score (Favourable - No grimace or facial grimace; Unfavourable – Any head, neck and limb movements or cough). Vocal cord movements were again assessed by an ENT surgeon 48 hours later.
Results: Demographic data, type and duration of surgery were similar in both groups. 63.4% of patients in Group A had favourable scores compared to 29.3% in Group M even though duration of laryngoscopy was longer in Group A. There was no significant difference in haemodynamic changes between the groups.
Conclusion: Patients are more comfortable during vocal cord assessment with Airtraq laryngoscopy even though duration of laryngoscopy is longer when compared to Macintosh laryngoscope.
Introduction: Estimation of weight is important in the intensive care unit but most ICUs do not have a weighing machine for these patients who are unable to stand up.
Aim: To compare the accuracy of estimation of weight by the physician, weight estimated using anthropological formulae with actual weight of the patient.
Methods: This was a prospective, observational, single centre study. A hundred adult patients, 18-60 years of age, of either gender, waiting for elective surgery in the preoperative waiting area, who were conscious and able to stand were enrolled for the study. The patient's actual weight and height were measured. Experienced anaesthesia consultant unaware of patient's actual weight, was asked to visually estimate the weight of the patient. The patient's height when supine, abdominal girth and length of tibia were measured. Patient's weight was calculated using various anthropological formulae
Results: The mean±SD age of the patients was 44.07±14.06 years. 49 were women and 51 were men. There was good correlation between weight estimated by the physician and as calculated by linear regression irrespective of their BMI. Calculated weight was close to actual weight only in patients with normal build but not with low or high BMI.
Conclusion: Estimation of patient body weight by an experienced clinician can be fairly reliable. For more objective estimations, linear regression using abdominal and thigh circumference can be used. Anthropometric formulae such as Miller's, Devine's, Robinson's and weight measured using tibial length overestimate weight at low BMI levels and underestimate when BMI is high.
Introduction: Cardiopulmonary resuscitation can be termed successful only if the victim survives to hospital discharge and returns to a reasonable quality of life.
Aim: The aim of this study was to determine long term survival and quality of life of patients who sustained in-hospital cardiac arrest.
Patients and Methods: This was a prospective interventional study of 1955 patients who sustained in- hospital cardiac arrest at a tertiary hospital in India. Adult patients who sustained cardiac arrest in the hospital were included in the study and patients who were < 18 years of age, cardiac arrest in operation theatre and patients who were brought in ‘near death’ state to the hospital were excluded. Parameters were collected during two periods, before and after introduction of Modified Early Warning Score (MEWS).
Results: In the PreMEWS period, 228 out of 1135 (20%) patients had return of spontaneous circulation (ROSC), of whom 59 survived to discharge (5.19%), 51 patients (4.49%) were alive at 6 months and 45 patients (3.96%) were independent at activities of daily living (ADL). In the PostMEWS period, 202 out of 820 patients (24.6%) had ROSC, of whom 138 patients (16.82%) survived to discharge, 110 were alive at 6 months (13.41%) and 99 (12.07%) were independent at ADL.
Conclusion: The rate of return of spontaneous circulation, survival to discharge rate, 6 month survival and independence at activities of daily living are all better with the use of modified early warning score.
Heat and moisture exchange filters (HMEFs) have been a controversial yet widely used adjunct to breathing circuit. Here we discuss a case scenario where clogging of HMEF with moisture presented as elevated peak airway pressures. Apart from stressing the importance of monitoring airway pressure, we discuss about the judicious use of HMEFs, problems associated with their use and measures to overcome the same. Being a ubiquitous adjunct, a thorough knowledge of its functioning and constant vigilance during its use is of paramount importance.