Anaesthesia and Critical Care

Ventricular assist devices (VAD) represent a revolution for the management of severe heart failure. Their insertion requires the use of cardiopulmonary bypass. They are used either permanently for long term treatment of refractory heart failure or temporally as a bridge until cardiac transplantation and until cardiac recovery from reversible cardiomyopathy. Insertion of VAD is a risky surgery with high incidence of complication such as bleeding, cardiac tamponade, renal failure and device failure. Anesthetic management of patients with heart failure undergoing VAD insertion requires full review of the patient critical condition, understanding VAD physiology, extensive hemodynamic monitoring and a harmony between cardiac anesthesia and surgical teams. Marinating and protection the right ventricular function is highly important for the continuation of VAD function. The aim of this review is to put new insights on anesthetic management of VAD insertion and to show their different types and their physiology.

Assessment and optimization of hemodynamic parameters and oxygen delivery may improve outcome in critically ill patients. Optimum fluid management often needs to take hemodynamic parameter in to account. Comorbidity and critical illness during pregnancy contribute significantly to maternal and fetal morbidity and mortality. This article will focus on the role of hemodynamic monitoring in the field of practice of obstetrics, perioperative and critical care management of obstetric patients with current evidence and type of hemodynamic monitoring technique for such patients. PubMed advanced and Google Scholar search with index word "hemodynamic monitoring", "haemodynamic monitoring", "shock", "obstetric", "preeclampsia", "heart disease", "cardiac disease", "hemodynamic monitoring in obstetric", "hemodynamic monitoring in obstetrics", and "haemodynamic monitoring in obstetric" in different combinations to retrieve clinical trials, case series, and review articles for the current literature review.

Introduction:- Ketamine and Fentanyl used intrathecally as adjuvant to 0.5% hyperbaric bupivacaine for patients undergoing TAH to shorten the onset of sensory and motor blockade and prolonging the duration of block.
Aims and Objective:-We evaluated onset and duration of sensory and motor blockade and timing of regression of sensory blockade to T 12 and motor blockade to Bromage scale 3.
Material and Methods:-This analytical Comparative Study was conducted in Department of Anaesthesiology, Era’s Lucknow Medical College and Hospital, Era University, Lucknow over a period of eighteen months from 2016 -2018 following approval from institutional ethical committee and written informed patient consent. The sample size of 162 female patient aged 40 to 60 years, belonging to ASA physical status 1 and 2 undergoing TAH were randomly allocated to three groups in double blind manner. Group I Received Inj. Bupivacaine (0.5% Heavy) 3.0ml + Inj. Ketamine (25 mg), Group II Received Inj. Bupivacaine (0.5% Heavy) 3.0 ml + Inj. Fentanyl (25 µgm), Group III (Control Group): Received Inj. Bupivacaine (0.5% Heavy) 3.0 ml + Normal saline 0.5 ml. Onset and Duration of Sensory and Motor Blockade and time taken for regression of sensory level to T12 and motor level to Bromage scale 3 noted.
Results:- The present study showed that both Ketamine as well as Fentanyl shortened the onset time and prolonged the block duration. However, with respect to onset time, ketamine has shorter onset of blockade than fentanyl.
Conclusion:- Both the modalities independently assured quicker onset and prolonged duration of block, thus suggesting that adjuvant use of either of two could be beneficial.

Hyperthyroidism is a common metabolic disorder with many cardiovascular manifestations. In rare cases, untreated hyperthyroidism can lead to thyrotoxic cardiomyopathy with severe left ventricular (LV) dysfunction and if its associated with myasthenia gravis it can result into the acute respiratory failure.This case report aims to discuss the pathogenesis of heart failure and respiratory failure in hyperthyroidism and the available treatment options. A 26 yrs old male patient with a past history of uncontrolled hyperthyroidism has presented with anxiety, difficult breathing and irrelevant talking. After doing examination and full workup he was found to have left ventricular failure and associated acute respiratory failure. Acute respiratory failure was a presentation of masked myasthenia gravis association. Beta-blockers and anti-thyroid medication was started and patient was stabilized. A good medical history along with clinical examination can reveal the diagnosis and the TSH level should be checked as a part of the initial laboratory workup of every patient with new-onset CHF. One should always keep association of myasthenia gravis in mind.

Background: We designed this study to expand the usage of ultrasound to detect early occurrence of hypovolemia. We explore the potential use of inferior vena cava (IVC) and abdominal aorta (AA) diameter index (IVC:AA) measured ultrasonographically to detect class 1 hypovolemic shock with blood loss less than 15%. Methods: The aim of this study was to determine the changes in the diameter of inferior vena cava and abdominal aorta in blood donors by using ultrasound, pre and post blood donation. The result of the study would be further explorated to determine the inferior vena cava (IVC) abdominal aorta (Aorta) diameter index (IVC:Aorta). This was a prospective study done in the blood bank of a university hospital. Researcher was trained by a senior radiologist to assess inferior vena cava and abdominal aorta diameter. Fifty-two healthy blood donors were included in the study. Inclusion criteria were same with the blood bank criteria to donate blood. Demographic data and vital signs were taken before the ultrasound measurement done for inferior vena cava and abdominal aorta diameter. Once the volunteers donated their blood of approximately 450 mls; the measurements were repeated using the same methods. Results: There were differences in IVC, abdominal aorta and inferior vena cava:aorta diameters index pre and post donation. With mathematical analysis, we suggested the number of IVC:Aorta index as 1.14±2SD with SD 0.18 as a cut off value for class 1 hypovolemic shock. Conclusion: The IVC:Aorta diameter index can be used as a parameter for detecting early phase (Class 1) of hypovolemic shock.

Introduction. The health locus of control gives a possibility to determine the patient's self-effi cacy resources, which are specifi c in locating health control actions. It also enables prediction of the type of health behaviours the patient will exhibit during recovery after a cardiac surgery. Aim. The aim of the study was to use the Multidimensional Health Locus of Control (MHLC) to assess the occurrence of the internal health locus of control (IHLC), powerful others (PHLC) and chance (CHLC) in patients undergoing coronary artery bypass grafting according to their sex, occupational activity and education. The occurrence of types of health locus of control was also assessed. Material and methods. 52 patients aged 47-63 years were tested (46 men -88.5% and 6 women -11.5%). The position of health control was tested by means of the Polish version of the American MHLC adapted by Juczyński. Results. The average scores were as follows: I -27.92 points, O -29.60 points, C -22.61 points. The research revealed statistical dependencies for some MHLC dimensions and for the sex and education. MHLC Type 7undifferentiated, strong (19 patients, 36.6%) was the most common.

Introduction Emotions and cognition are tightly bound entities that have clear functional and organic basis [1]. Both of them can be disturbed in hospitalized patient. Negative emotions, like fear and anxiety infl uence the patients undergoing anaesthesia regardless of age, and this impact has been extensively discussed in the literature [2–4]. On the other hand, cognition is affected by perioperative stress and anaesthesia infl u-encing the quality of life which has also been well described by Steinmetz et al. [5]. Emotions and cogni-tion are also engaged in the process of time production [6]. We know from the previous studies that anxiety and depression affect the intestinal motor function [7, 8]. These facts inspired us to construct the study assessing the relationship between emotional and cognitive aspect of time perception in relation to intravenous anaesthesia for endoscopic procedures. Especially that brain regions responsible for the interval timing (corticostriatal circuits and dopamine neu-rons) are closely related to cognitive phenomena and can be discussed as a part of human cognitive func-ABSTRACT Introduction. The basic goals of the study were to analyze how patients receiving intravenous anaesthesia for endoscopy produce one-minute time intervals after anaesthesia, and to characterize the relationship between attitude towards time and the production of one-minute intervals. Material and methods. Twenty four intravenously anesthetized patients constituted the Anaesthesia Group and 25 nonanesthetized patients formed the Control Group. The Mini-Mental State Examination and the Sense of Coherence Meaningfulness Subscale were used to recognize the problem of dementia and depression, the Time Metaphors Questionnaire was used for the assessment attitudes toward time. Time production of one-minute was measured three times in each of four sessions. Results. The tested participants of both groups shortened the one-minute intervals. Duration of anaesthesia did not affect the time production. Perceiving time as empty and meaningless was related with misestimating time after colonoscopy. Conclusions. Time interpretation by using metaphors and time production are related with each other.