Volume 4 Issue 1

Case Report: Anesthetic Management for Anterior Mediastinal Mass with Strong Family History of Malignant Hyperthermia

Waleed Elmatite*, Surjya Upadhyay, Waseem Alfahel, Ramiro Mireles, Robert Ramsdell and Stacey Watt

Anesthesia for children with anterior mediastinal masses can present life-threatening and hemodynamic challenges in the perioperative period. We encountered a two-year-old child with a family history of malignant hyperthermia and a symptomatic anterior mediastinal mass due to significant airway compression. This case report describes an alternative technique of airway management by keeping the child breathing spontaneously without using inhalational anaesthetics and discusses other potential airway management techniques.

Cite this Article: Elmatite W, Upadhyay S, Alfahel W, Mireles R, Ramsdell R, et al. Anesthetic Management for Anterior Mediastinal Mass with Strong Family History of Malignant Hyperthermia. Am J Anesth Clin Res. 2018;4(1): 015-018.

Published: 16 July 2018

Review Article: Predicting Perioperative Fluid Responsiveness in Pediatric Patients; how it Differ from the Adults?

Waleed Elmatite1 and Surjya Upadhyay2*

Accurate Prediction of fluid responsiveness can be challenging, particularly in children. Although, fluid administration is the main stay of resuscitation during pediatric surgery associated with significant blood or third space loss, volume overload is frequently encountered in small children and is often associated with adverse outcomes. The parameters used to assess fluid responsive are basically classified into two categories, static and dynamic parameters. Static parameters like central venous pressure measurement are slowly becoming unpopular and are replaced by dynamic parameters which rely on the heart-lung interactions are more accurate predictors of fluid responsiveness. Unlike adults, there are insufficient data on the efficacy of dynamic variables for the prediction of fluid responsiveness in children. In this review article we discuss the strengths and limitations of both the static and dynamic parameters for assessing the fluid responsiveness in the perioperative period in pediatric patients.
Keywords: Fluid responsiveness; Pediatric surgery; Dynamic parameters; Static parameters

Cite this Article: Elmatite W, Upadhyay S. Predicting Perioperative Fluid Responsiveness in Pediatric Patients; how it Differ from the Adults? Am J Anesth Clin Res. 2018;4(1): 008-014.

Published: 04 July 2018

Brief Communication: Current Faults and Recommendations for Transfusion of Red Blood Cell Assessment and Clinical Evaluation of Changes in Hematocrit

Andrey Belousov*

The focus of the article is situated on current faults and recommendations for transfusion of red blood cell assessment and clinical evaluation of changes in hematocrit. The main task of therapy for acute massive blood loss is not urgent thoughtless transfusion of red blood cells for the fast recovery of the hemoglobin and hematocrit levels. The oxygen-carrying capacity of blood does not directly reflect the delivery of oxygen to tissues. The severity of the patient's condition depends on the individual ability of the organism to resist hypoxia, mechanisms resulting in physiological compensation for the anemia caused by blood loss. The main tasks of therapy are timely maintaining appropriate and effective compensatory-adaptive reactions of an organism and providing of the sanogenetic processes. Quickly and comfortable algorithm assessment changes in hematocrit were presented for use in practice. Objective analysis of hematocrit and hemoglobin levels should be carried out only in combination with data on blood pressure, pulse rate, respiratory rate, urine output and shock index.

Cite this Article: Belousov A. Current Faults and Recommendations for Transfusion of Red Blood Cell Assessment and Clinical Evaluation of Changes in Hematocrit. Am J Anesth Clin Res. 2018;4(1): 001-007.

Published: 14 April 2018

Clinical Study: Logistic Challenges in Renal Access Salvage

Kristy Kehoe, Kirsty Hudson, Joanna Janczyk, Sharon Yen Ming Chan, Ben Cooper and Bryce Renwick*

Objective: To elicit the efficacy of hybrid thrombectomy procedures for renal access salvage.
Background: Fistula thrombosis is a well recognised complication of patients undergoing haemodialysis. Salvage of thrombosed fistulae requires urgent intervention. Hybrid thrombectomy and fistuloplasty procedures require the coordinated efforts of the anesthetic, interventional radiology and vascular surgical teams.
Methods: All emergency renal access referrals made to a renal access unit over a 12 month period were analysed. 21 patients in total underwent a combined or hybrid thrombectomy of thrombosed fistula.
Results: We found that prosthetic graft thrombosis accounted for the majority of thrombosed fistulae and moreover, were much more likely to re-thrombose following salvage relative to primary vein fistula. The number of patients subsequently undergoing dialysis on the same fistula successfully at 3 and 6 months dropped significantly.
Conclusion: When combined with significant re-intervention rate, these findings are suggestive of a need for enhanced renal access surveillance, more so in prosthetic grafts.
Keywords: Hybrid thrombectomy; Renal Salvage; Haemodialysis

Cite this Article: Kehoe K, Hudson K, Janczyk J, Ming Chan SY, Renwick B, et al. Logistic Challenges in Renal Access Salvage. Am J Anesth Clin Res. 2018;4(1): 001-003.

Published: 10 March 2018

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