Journal of Clinical Anesthesiology: Open Access

Traumatic brain injury is a major public health concern not only in our country but everywhere else. It is an emerging research priority which needs to be extensively studied keeping in mind its huge burden on public health. But in our country there is lack of scientific research and education in field of trauma. It affects a large proportion of individual. Road traffic accidents contributes to the major burden of Traumatic brain injury. The definition of TBI is an‘alteration in brain function, or other evidence of brain pathology, caused by an external force’. However, this unitary epidemiological definition encompasses a complex disease process with diverse injury subtypes that may overlap. There is an increasing drive to differentiate these subtypes to allow precision-medicine approaches to management

Background: As the number of total joint arthroplasty (TJA) cases continues to grow operating room (OR) suites can evaluate parallel processing strategies to reduce the length of time the patient is in the OR as a mechanism to increase throughput of cases. The goals of this study were to 1) assess the safety and success rate of performing spinal anesthesia in the hospital preoperative area and 2) measure the OR times for patients after the first case of the day undergoing total hip (THA) or knee arthroplasty (TKA) in an inpatient setting.

Methods: A retrospective review of electronic medical records (EMR) was performed on all patients after the first case of the day who underwent unilateral THA or TKA via spinal anesthesia by three orthopedic surgeons between January 2017 and December 2018. Spinal anesthesia was performed based on anesthesiologist preference either in the OR or in the preoperative holding area. Measured OR times included time from patient entry into the OR to: incision, surgery closure end, OR exit, and discharge from the Post Anesthesia Care Unit (PACU). Spinal anesthesia failure (inability to perform surgery without conversion to general anesthesia), high spinals requiring airway management, hypotension or bradycardia needing treatment in the holding area, and cardiac arrest were the primary clinical adverse events abstracted from the EMR.

Results: Twenty-five % (n=398) of a total of 1594 TJAs (720 THAs and 874 TKAs, 924 females and 572 males) received spinal anesthesia by 8 anesthesiologists in the preoperative holding area, with the remaining 1,196 patients receiving the spinal anesthetic in the OR. These 398 TJA patients had a mean and standard deviation (SD) of 70.7 (10.3) years of age, body mass index of 30.4 (6.7), American Society of Anesthesiologists (ASA) Physical Status of 2.3 (0.5) with 269 ASA 2 patients and 129 ASA 3 patients, with 36% males, and 42% undergoing THA. 100% of patients successfully had the spinal anesthetic with isobaric bupivacaine 0.5% (no additives) placed in the preoperative area, with no high spinals, and the time in minutes from entering the OR to: incision equaled mean (SD) of 42 (16), to surgery closure end 140 (21), OR exit 155 (20), and PACU discharge 297 (90). Complications included emesis (n=2), and persistent hypotension (n=4).

Conclusions: All 398 TJA patients had a spinal anesthetic successfully placed in the preoperative area with a minimal number of complications which provides evidence that anesthesiologists can choose patients in which spinal anesthesia is feasible and can be performed safely in the preoperative holding area. 

Covid has led to innovations and strategies, primarily to manage patients with hypoxia and respiratory failure. Although devastating, the pandemic brought the best out of the medical fraternity in terms of patient care and research. Undoubtedly, invasive ventilation is the last resort in patients with progressive dyspnea not manageable with non-invasive methods; still, non-invasive ventilation methods are becoming popular and have proven their worth. CPAP and Bipap played a vital role during the first and second pandemic waves, with HFNC gradually becoming popular with the intensivists and ICU physicians because of its unique advantages(1).