Retrospective Analysis of Postoperative Nonhepatic Outcomes Following Major Liver Resection.

Background Liver surgery is a major and challenging procedure for the surgeon, the anesthetist, and the patient. The objective of this study was to evaluate the postoperative nonhepatic complications of patients undergoing liver resection surgery with perioperative factors. Methods We retrospectively analyzed 79 patients who underwent liver resection surgeries at the Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Pakistan, from July 2015 to December 2022. Results The mean age at the time of surgery was 53 years (range: 3-77 years), and the mean BMI was 26.43 (range: 15.72-38.0 kg/m2). Of the total patients, 44.3 % (n = 35) had no comorbidities, 26.6% (n=21) had one comorbidity, and 29.1% (n=23) had two or more comorbidities. Patients in whom the blood loss was more than 375 ml required postoperative oxygen inhalation with a significant relative risk of 2.6 (p=0.0392) and an odds ratio of 3.5 (p=0.0327). Similarly, patients who had a surgery time of more than five hours stayed in the hospital for more than seven days, with a statistically significant relative risk of 2.7 (p=0.0003) and odds ratio of 7.64 (p=0.0001). The duration of surgery was also linked with the possibility of requiring respiratory support, with a relative risk of 5.0 (p=0.0134) and odds ratio of 5.73 (p=0.1190). Conclusion Patients in our cohort who had a prolonged duration of surgery received an increased amount of fluids, and a large volume of blood loss was associated with prolonged stay in the ICU (>2 days), hospital admission (>7 days), ICU readmission, and increased incidence of cardiorespiratory, neurological, and renal disturbances postoperatively.

Anesthetic Management of Emergency Insulinoma Resection: Case Report and Review of Literature.

Insulinoma, a neuroendocrine tumor originating from pancreatic islets, presents unique challenges in diagnosis and management. We present a case of a 73-year-old female with recurrent hypoglycemia leading to syncope, who underwent emergency pancreatectomy for a secreting insulinoma with multiple comorbidities. This case report aims to shed light on the complexities of insulinoma management and the importance of tailored perioperative strategies. The patient, presenting with severe hypoglycemia, was admitted for optimization. Preoperative assessment labeled her as ASA IVE and indicated a high risk of perioperative morbidity. General anesthesia, invasive monitoring, and epidural anesthesia were planned. Intraoperative glucose control was crucial, achieved with continuous blood glucose monitoring, octreotide administration, and insulin titration. The patient was extubated post-surgery, and pain was managed with epidural infusion. She was discharged on the 4th postoperative day with follow-up care. Insulinoma diagnosis relies on clinical, biochemical, and imaging tests, with 72-hour fasting as the gold standard. Localizing the tumor within the pancreas is essential for surgical success, often requiring invasive techniques. Surgical resection remains the definitive treatment, while medical management may be necessary in select cases. Anesthetic management should prioritize agents that minimize the cerebral metabolic rate for oxygen. Careful intraoperative glucose control and vigilant postoperative monitoring are essential. This case report highlights the intricate management of insulinoma, emphasizing tailored perioperative strategies that balance glucose regulation, anesthesia techniques, and postoperative care. However, the limited existing literature underscores the need for further research to refine anesthesia protocols, glucose control methods, and postoperative care, ultimately improving outcomes for patients with insulinoma.

Tonsillar Trauma During Video Laryngoscopy: A Case Report.

Potentially difficult airways warrant the use of airway adjuncts, which, if not used with caution, can cause trauma to the oral cavity. Although most operators are familiar with modern airway adjuncts, as they are not routinely used, adverse events can occur. Since its introduction, a video laryngoscope (VL) has been lauded as a necessary instrument for airway management in and out of the operating room. This case report highlights right tonsillar tissue perforation with a GlideScope® VL (Verathon Incorporated, Bothell, Washington, USA), requiring primary closure by an otolaryngologist.

Impact Of Incentive-Based Game Therapy And Transporting Children On Toy Vehicle To Operation Theatre On Reducing Anxiety Prior To Induction Of Anesthesia.

OBJECTIVE: To see if transporting paediatric patents to operation theatres using a battery operated vehicle decreases preoperative anxiety and reduce incidents of postoperative adverse events. METHODS: The study was conducted from May to August 2019 at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised paediatric patients aged 3-5 years assessed as American Society of Anaesthesiologists grade I and II who were scheduled to undergo elective intrathecal chemotherapy under general anaesthesia. The subjects were randomised into intervention group A and control group B. Patients in group A were part of an incentive-based game in the holding bay area and were transported to the operation theatre using a battery-operated toy vehicle. Those in group B watched a pre-decided cartoon on television screen in the holding bay and were transported further using wheel chair. Induction of anaesthesia was done in the presence of guardians in both the groups. Patient anxiety was assessed using the modified Yale Preoperative Anxiety Scale in holding bay area T0, prior to induction of anaesthesia T1, and postoperative anaesthesia-related recovery T2. Data was analysed using SPSS 22. RESULTS: Of the 36 patients, 18(50%) were in group A; 12(66.6%) boys and 6(33.3%) girls with mean age 4.01±0.48 years. The remaining 18(50%) subjects were in group B; 13(72.2%) boys and 5(27.8%) girls with mean age 3.96 years. The difference in anxiety between the groups at T0 was non-significant (p=0.73). At T1 and T2, the scores were significantly lower group A compared to group B (p<0.05). Group A patients had better bag mask ventilation compliance at induction and remarkably less incidence of hypoxia, bronchospasm, postoperative agitation and early discharge from PACU. CONCLUSIONS: Incentive-based game therapy decreased anxiety among paediatric patients preoperatively, made them more compliant and improved postoperative recovery.

Emergency Management of Ventilation Failure Through Blocked Tracheostomy Tube in a Paediatric Patient.

The most common complication of tracheostomy tubes in children is blockage of the tube. We report a case where ventilation after induction of anaesthesia was not possible even though there were no signs of impending obstruction. An eight-year-old child, recently diagnosed with left tonsillar embryonal rhabdomyosarcoma, presented for an MRI face and bone marrow biopsy before starting treatment. Due to difficulty in breathing, the patient had undergone a tracheostomy at a different institute and a size six uncuffed tracheostomy tube was in situ. There was difficulty in ventilating the patient due to blockage in the tracheostomy tube which was addressed and the patient was discharged after successful completion of both the procedures. This case highlights the importance of following an emergency algorithm for failure to ventilate in a patient with a tracheostomy tube, identifying the cause and treating it.

Clinical Practice for Venous Thromboembolism Prophylaxis in Patients Undergoing Oncological Surgeries.

Objective To determine the proportion of patients receiving venous thromboembolism (VTE) prophylaxis after oncological surgeries as per the hospital standards and its comparison with the international guidelines. Methodology In the month of September 2019, all patients after elective oncological surgeries were reviewed for VTE prophylaxis administration and education. Results were shared with the department of surgery and Hospital Quality and Patient Safety Department. Education was provided to the relevant staff and hospital policy for VTE prophylaxis was revised followed by a loop audit which was done in October 2020. The primary endpoint was to compare the proportion of patients receiving prophylaxis as per the hospital guidelines. Results Total 425 patients were included in this audit (209 in September 2019 and 216 in October 2020). Compliance with mechanical prophylaxis increased from 84.7 % to 98.6% and pharmacological prophylaxis improved from 39.7% (n=83) to 73.1% (n=158). Adherence to local protocols enhanced significantly from 1.9% (n=4) to 56.4% (n=122). The main cause of non-compliance was lack of risk assessment for VTE. Conclusion VTE prophylaxis can be improved by setting protocols in accordance with the international guidelines and local protocols. This can prevent significant morbidity and mortality in surgical patients as well as hospital costs.