Neelakantan Sunder

Crisis resource management training for an anaesthesia faculty: a new approach to continuing education

Background  Human error and system failures continue to play a substantial role in adverse outcomes in health care. Anaesthesia crisis resource management addresses many patient safety issues by teaching behavioural skills for critical events but it has not been systematically utilized to teach experienced faculty.

Role of histamine in the hemodynamic and plasma catecholamine responses to morphine

The role of histamine in the hemodynamic and plasma catecholamine responses to intravenous morphine in subjects without cardiovascular disease and not receiving prior medication has not been reported. Systemic hemodynamics and serum histamine and plasma catecholamine concentrations were measured in 10 subjects before and 2, 5, 10, and 20 min after, 0.3 mg kg−1 IV morphine. Serum histamine concentration increased 2, 5, and 10 min after the morphine. Systolic and mean arterial pressures and systemic vascular resistance decreased and cardiac output increased because of increases in heart rate and stroke volume. The most important changes in hemodynamic function occurred after 2 min in association with a 400% increase in serum histamine concentration; these variables, together with serum histamine concentration, returned toward baseline values after 20 min. There was a negative correlation between peak increase in serum histamine concentration and maximum decrease in systemic vascular resistance. Plasma epinephrine concentrations were elevated 5, 10, and 20 min after morphine injection, suggesting activation of the adrenal medulla by histamine. Our data suggest that histamine plays an important role in the acute hemodynamic and plasma epinephrine response to morphine.

Cerebrospinal Fluid Aβ to Tau Ratio and Postoperative Cognitive Change

Objective: Determination of biomarker and neuropathogenesis of postoperative cognitive change (POCC) or postoperative cognitive dysfunction. Background: POCC is one of the most common postoperative complications in elderly patients. Whether preoperative cerebrospinal fluid (CSF) &bgr;-amyloid protein (A&bgr;) to tau ratio, an Alzheimer disease biomarker, is a biomarker for risk of POCC remains unknown. We therefore set out to assess the association between preoperative CSF A&bgr;42 or A&bgr;40 to tau ratio and POCC. Methods: Patients who had total hip/knee replacement were enrolled. The CSF was obtained during the administration of spinal anesthesia. Cognitive tests were performed with these participants at 1 week before and at 1 week and 3 to 6 months after the surgery. Z scores of the changes from preoperative to postoperative on several key domains of the cognitive battery were determined. We then examined the association between preoperative CSF A&bgr;42/tau or A&bgr;40/tau ratio and the outcome measures described earlier, adjusting for age and sex. Results: Among the 136 participants (mean age = 71 ± 5 years; 55% men), preoperative CSF A&bgr;42/tau ratio was associated with postoperative Hopkins Verbal Learning Test Retention [Z score = 8.351; age, sex-adjusted (adj.) P = 0.003], and the Benton Judgment of Line Orientation (Z score = 1.242; adj. P = 0.007). A&bgr;40/tau ratio was associated with Brief Visuospatial Memory Test Total Recall (Z score = 1.045; adj. P = 0.044). Conclusions: Preoperative CSF A&bgr;/tau ratio is associated with postoperative changes in specific cognitive domains. The presence of the Alzheimers disease biomarker, specifically the A&bgr;/tau ratio, may identify patients at higher risk for cognitive changes after surgery.

Preoperative cerebrospinal fluid β‐Amyloid/Tau ratio and postoperative delirium

The neuropathogenesis of postoperative delirium remains unknown. Low cerebrospinal fluid (CSF) β‐amyloid protein (Aβ) and high CSF Tau levels are associated with Alzheimers disease. We, therefore, assessed whether lower preoperative CSF Aβ/Tau ratio was associated with higher incidence and greater severity of postoperative delirium.

Continuous axillary block through an indwelling Teflon catheter.

Continuous regional anesthesia through a catheter placed in the axillary sheath has been an effective method of brachial plexus neural blockade. This article confirms this observation and demonstrates that continuous axillary block is useful in replantation surgery to provide anesthesia and analgesia in addition to sympathetic blockade for up to 7 days after operation. This anesthetic technique may allow extensive revascularization or replantation procedures to be performed for patients who could not safely tolerate prolonged application of general anesthesia.

Peritonitis in patients over the age of 50 years : 98 cases managed surgically

Generalized peritonitis in patients over the age of 50 years is a common surgical emergency. This is a retrospective analysis of 98 cases managed surgically. Duodenal ulcer perforations, necrotizing enteritis, acute cholecystitis with perforation and small bowel perforations were the common causes. Most of them presented late, and many had associated conditions. Re-look laparotomies had a definite role to play. While there is significant decrease in the number of typhoid and tubercular peritonitis, there appears to be an increase in the incidence of necrotizing enteritis and acute cholecystitis.

A randomized comparison of labetalol and nitroprusside for induced hypotension

In a randomized study, labetalol-induced hypotension and nitroprusside-induced hypotension were compared in 20 patients (10 in each group) scheduled for major orthopedic procedures. Each patient was subjected to an identical anesthetic protocol and similar drug-induced reductions in mean arterial blood pressure (BP) (50 to 55 mmHg). Nitroprusside infusion was associated with a significant (p less than 0.05) increase in heart rate and cardiac output; rebound hypertension was observed in three patients after discontinuation of nitroprusside. Labetalol administration was not associated with any of these findings. Arterial PO2 decreased in both groups. It was concluded that labetalol offers advantages over nitroprusside.

Anesthesia services during operation unified assistance, aboard the USNS mercy, after the tsunami in southeast asia

The tsunami that struck Southeast Asia on December 26, 2004, resulted in the deaths of >300,000 individuals. The U.S. response included the formation of the first combined civilian/ military peacetime humanitarian effort, directed by the National Command Authority as Operation Unified Assistance. This effort included military personnel from the U.S. Navy and civilians assembled by Project HOPE. Anesthesiologists and certified nurse anesthetists provided care in >150 cases. We discuss the initial response, medical and cultural planning, logistical support, procedures, and lessons learned in this unique opportunity.