Evaluation of the HemoCue® for blood loss estimation in suction fluid in patients undergoing neurosurgical procedures: A prospective observational study.

Background and Aims: Blood loss in neurosurgical procedures can be rapid and tremendous leading to consequential hemodynamic instability. HemoCue is a portable photometer used for the measurement of blood hemoglobin concentration. Using this point of care device, we contemplated this study to assess the reliability of HemoCue for suction hemoglobin determination and calculation of surgical blood loss by comparing with the gold standard laboratory Coulter Counter method in patients undergoing neurosurgical procedures. Material and Methods: This prospective observational study was conducted in 233 patients undergoing elective neurosurgical procedures in the age group of 18 to 60 years and having preoperative hemoglobin (Hb) values above 9 g/dL. Values of preoperative hemoglobin, suction hemoglobin, and volume in the suction container were used to obtain the estimated blood loss. The normality of the data was tested using the Kolmogorov Smirnov test. Bland Altman analysis was used to test the reliability of HemoCue in estimating hemoglobin and blood loss with reference to the gold standard laboratory Coulter Counter automated hematology analyzer. Results: Median blood loss calculated in our study using HemoCue was 554.65 mL with an interquartile range of 336.81 mL to 982.39 mL. Laboratory counter method estimated median blood loss was 533.37 mL with an interquartile range of 335.21 mL to 994.73 mL. The majority of the data obtained and analyzed using the Bland and Altman analysis method were within a 95% confidence interval. Conclusion: The HemoCue method is a reliable method and henceforth can be used to estimate blood loss in suction fluid in patients undergoing neurosurgical procedures.

Physiological Changes in Pregnancy.

Pregnancy is a dynamic process, which induces a multitude of anatomic, physiological, biochemical, and psychological changes. Physiological changes during pregnancy allow the body to meet the increased metabolic demands of the mother and fetus by maintaining adequate uteroplacental circulation, and ensure fetal growth and development. These changes begin early in the first trimester and are brought on by the increased circulating levels of progesterone and estrogen, which are produced by the ovary in the first 12 weeks of pregnancy and thereafter by the placenta. While some of these cause a change in biochemical values, others may mimic symptoms of medical disease. For instance, cardiac changes such as sinus tachycardia, systolic heart murmurs, and cardiac enlargement could be interpreted as signs of heart disease. It is thus crucial, to differentiate between normal physiological changes and pathological changes, particularly for clinicians involved in the care of pregnant patient. How to cite this article: Gangakhedkar GR, Kulkarni AP. Physiological Changes in Pregnancy. Indian J Crit Care Med 2021; 25(Suppl 3):S189-S192.

A rare occurrence of accidental exposure to UV radiation among operating theatre personnel.

Ultraviolet (UV) lamps are commonly used in operation theatres for disinfection. Accidental exposure causes damage to superficial tissues especially the skin, the eyes and has the potential to cause various malignancies. Nine previously asymptomatic operation theaters (OT) personnel experienced, foreign body sensation with intense tearing of eyes and erythematous rash on exposed body parts 2 to 4 hours after leaving work. They required symptomatic treatment with oral and topical antihistaminics and lubricant eye drops. Two of the nine required intravenous steroids. UV exposure was diagnosed as diagnosis of exclusion. There is a lack of knowledge regarding presence UV radiation in OT and a lack of safety measures in place to prevent exposure. This case report emphasises the threats poses by UV exposure, the need to bring about awareness about the presence of UV lamps and adopting safety measures to avoid exposure among healthcare providers.

Emergency caesarean section of a patient with eisenmenger's syndrome: A tight-rope walk.

Successful management of a pregnant patient with complex congenital heart disease is a challenge for anesthesiologists, requiring thorough knowledge of the impact of pregnancy on the cardiac lesion. Hearing and speech impaired patients pose a barrier to effective communication between the patient and the doctors, thus increasing the anxiety and risk of complications. Here, we present a case of a hearing and speech impaired woman with the rare and dangerous Eisenmenger's syndrome, presenting for an emergency cesarean section (CS).

Pneumothorax Following Bougie-guided Intubation in a Difficult Airway: A Report of Two Cases.

Patients coming for atlantoaxial dislocation surgery represent a unique subset of difficult intubation. In addition to having restricted neck movements, excessive movements at the neck joint during intubation must be avoided to avoid further compression. In view of the anticipated difficult intubation, adjuncts or introducers may be required to aid intubation, the most commonly used being bougies. Complications are known to occur with the use of bougies but fortunately the incidences are far and few. The most dreaded of these is pneumothorax, secondary to trauma by the bougie. The use of an adult bougie for pediatric intubations could possibly increase the risk of the same. Here, we report two incidences of pneumothorax after bougie-guided intubation.

A prospective randomized double-blind study to compare the early recovery profiles of desflurane and sevoflurane in patients undergoing laparoscopic cholecystectomy.

BACKGROUND AND AIMS: General anesthesia using agents like Desflurane or Sevoflurane are beneficial for early recovery especially for ambulatory procedures. The aim of this randomised controlled double-blind study was to compare the early recovery profiles of sevoflurane and desflurane in patients undergoing laparoscopic cholecystectomy. MATERIAL AND METHODS: ASA I, II patients, undergoing laparoscopic cholecystectomy were randomly assigned to receive desflurane (n = 30) or sevoflurane (n = 30), using Bispectral Index System (BIS) to determine the depth of anaesthesia. An independent adjudicator, who was blinded to the agent used, recorded the events during the recovery phase. The time required for extubation, eye opening, verbal response and achievement of a modified Aldrete score of 9 were recorded. RESULTS: The time required for extubation and for eye opening was significantly shorter in the Desflurane group as compared to the Sevoflurane group [9.1 min ± 5.0 versus 12.5 min ± 7.1, P = 0.049 and 10.1 min ± 5.2 versus 6.3 min ± 4.0, P = 0.008]. Verbal Response also occurred significantly faster in the Desflurane group [12.7 min ± 5.4 versus 8.7 min ± 4.7, P = 0.002]. A significantly higher mean modified Aldrete score was seen at extubation [7.1 ± 0.6 vs 6.0 ± 0.8, P < 0.001] in the Desflurane group, which also achieved a modified Aldrete score of ≥9 significantly sooner [11.1 min ± 4.6 versus 17.8 min ± 6.9, P < 0.001] than the Sevoflurane group. The frequency of adverse effects was not significantly different in either of the groups. CONCLUSION: The time required for early recovery from anaesthesia, was significantly shorter in the Desflurane group compared to the Sevoflurane group.