4^th International Anesthesia and Pain Medicine Conference December 13-14, 2018 Abu Dhabi, UAE

Extensive and diverse experience in vascular Anesthesia and vascular service development. A special interest in regional Anesthesia in vascular patients aiming for a better perioperative care and an enhanced recovery, with appropriate training and experience with quality improvement projects. International and national experience in education, management and leadership.

Background: How common is Anaemia? Anaemia accounts for 8.8% of disability from all conditions. In the elderly, 11% of males and 10.2% of females aged > 65 years, rising to 26.1% and 20.1% respectively in those > 85 years old. Most of these patients are elderly, have IHD, diabetics, and have chronic kidney disease. Partridge J, Harari D, Gossage J, Dhesi J. Anaemia in the older surgical patient: a review of prevalence, causes, implications and management. Journal of the Royal Society of Medicine. Target: When using a restrictive red blood cell transfusion threshold, consider a threshold of 70 g/litre (80 for ACS) and a haemoglobin concentration target of 70–90 g/litre (80-100 for ACS) after transfusion. Alternatives to blood transfusion for patients having surgery: Erythropoietin Intravenous and oral iron & Cell salvage and tranexamic acid. Consider intraoperative cell salvage with tranexamic acid for patients who are expected to lose a very high volume of blood (for example in cardiac and complex vascular surgery, major obstetric procedures, and pel vic reconstruction and scoliosis surgery). Conclusion: Preoperative Anaemia is a common finding in vascular surgical patients. Preoperative Anaemia is associated with intraoperative and postoperative autologous blood transfusion as well as increased hosp LOS CoCH preoperative anaemia in vasc surg pts is mostly treated with blood transfusion. NG24 recommends using oral and intravenous Fe++ for Rx preoperative anaemia and adopting a restrictive transfusion protocol – we are not compliant (based on data here)

Muhammad Aulia Arifahmi has completed his first degree at the age of 25 and now a resident of Department of Anesthesiology and Intensive care at Faculty of Medicine, Brawijaya University. This is the first paper to submit at international meeting as a student.

Brain abscesses secondary to heart disease are the most frequent etiology with an incidence reported of 5 to18 %, commonly found in developing countries.[1] Any patient with congenital heart disease, particularly cyanotic, the development of focal neurologic abnormalities or evidence of increased intracranial pressure must be considered as indicative of the possible presence of a brain abscess until proved otherwise.[2] In this case, a 5 year old male children with Atresia Pulmonal, Ventricular Septal Defect, Patent Ductus Arteriosus, Overriding Aorta, Mayor Aorto Pulmonary Collateral Artery had history of multiple generalized seizure, altered mental state E3V3M5 and fever. Head CT scan imaging shown multiple cystic lession at right temporoparietal lobe with subfalcine and trantentorial herniation suggesting brain abcess. We diagnosed this patient had a brain abscess and start the initial antibiotic treatment with ceftriaxone and metronidazole. Then, the neurosurgery team decided to evacuate the abscess via surgical boorhole. The surgical procedure had done with general anesthesia was succesfully performed without altered hemodynamic condition and followed by post operative care management in PICU for two days. The patient fully recovered 20 days after surgery. Anesthetic management in patient with brain abscess and cyanotic congenital heart disease is very challenging because we will face multiple problems. The patients tends to fall further to hipoxic condition, with hypercoagulable states, possibility of cyanotic spell and cardioplumonary circulation instability along with increased intracranial pressure and its complication, and how to maintain the balance of brain protection anesthesia and its impact on already impaired cardiopulmonary system.

Samie completed his MBBS in Punjab Medical College, also has completed the post graduate in FCPS Anaesthesiology, Faisalabadis was Post Fellowship (FCPS Anaesthesiology Experience): 3 years, (6 Months in General Paediatrics, 3 Months in Adult Cardiac Surgery, 3 Months Paediatric Cardiac Surgery. He is expertise in the field of anesthesiology, Pain Relief in Elective Single-level Microdisectomy Surgery, intraoperative ventilatory management of adult tracheoesophageal fistula, Anesthetic management of thoraco-omphalopagus twins with congenital heart disease for separation surgery.

Many different types of gastrointestinal procedures e.g. ERCP, gastroscopy are carried out under the supervision of Anesthesia. There is constant discussion regarding the safety of MAC(monitored anesthesia care) with the patient in the prone position because of concerns regarding airway safety during endoscopic procedures when access to the oropharynx is already limited. Primary Objective was to study risks (adverse event) and patterns of patient coming for gastrointestinal procedures under MAC or conscious sedation. Secondary objective was to study the stress caused to anesthetists for endoscopic procedures. Cross sectional observational analysis. Six to eight months after ARC and ethical approval. Sample size calculation is based on previous studies in which 50% adverse event was reported; therefore 267 patients undergoing ERCP (and other GI procedures) will be needed to estimate the expected frequency of intraoperative adverse event within 5% margin of error and 95% confidence interval. 262 patients were studied. Most common intraoperative event was tachycardia which occured in 43.5 % patients whereas bradycardia occurred in only 3 % of cases. 32.1 % of patients had an event of desaturation below 90 % and 10.7 % had a desaturation less that 85 %. 8.4 % of patients needed a nasopharyngeal airway for airway patency and in 3.8 % of patients the procedure had to be stopped and bag mask ventilation done. 10 % of patients had an episode of regurgitation and vomiting. In 8.4 % of cases there was bile on orapharengeal suction. In terms of the depth of sedation 85.5 % were deeply sedated with minimal or no response to stimulation. In terms of stress on anaethestist 19 % reported moderate to severe stress and 55 % reported mild stress. The incidence of complications is higher than routine ASA 1 & 2 procedures under general Anesthesia.

Ayesha Ali work as a consultant paediatric Anesthesia and paediatric pain management in KKH, which is theonly paediatric hospital in Singapore. The hospital has all the sub-specialty in paediatric surgery and do about 600+ theatre cases per year in all the sub-specialty excluding cardiac surgery and manage over 700+ cases for paediatric pain management per year. The specialties in general surgery include thoracic, upper GI, lower GI, oncology and urology, orthopedic specialty including scoliosis surgery. ENT including airway surgery, plastic specialty including cleft surgery. There are regular endoscopy lists where I teach deep sedation with TCI intravenous agents, and sedation for procedural pain. She is also involved in cardiac catheter lists and paediatric radiology lists.

Concern has been raised on the potential deleterious neurocognitive effects of general anesthesia during infancy and early life. Although there are no definitive data to prove this effect, the neonatal and infancy period has been suggested to be the most vulnerable period, and some studies observed an association between exposure to general anesthesia as an infant, and later neurobehavioral problems in childhood. The potential neurocognitive effects of various general anesthetic agents have been demonstrated in laboratory animals and suggested from retrospective clinical trials. The anesthetic agents identified as possible neurotoxins include either γ-amino-butyric-acid (GABA) agonists including the volatile anesthetic agents, benzodiazepines, barbiturates or N-methyl-D-aspartate (NMDA) antagonists such as ketamine. Although regional anesthesia is an acceptable alternative, many surgical procedures may not be amenable to regional anesthesia. Dexmedetomidine and remifentanil on the other hand, seem to be spared of such controversy, however limited data are available regarding their combined use during surgery in infants and Anesthesia. We herein present a case of a 3 month 3 week old infant who presented for examination under anesthesia of bilateral ears as well as Posterior Sagittal Anorectoplasty for anorectal malformation, for which general anesthesia was provided by using a combination of remifentanil and dexmedetomidine .

Ahmad Saqer has graduated from the University of Sharjah in 2018. He is currently working as a medical intern in Al-Ain Hospital. He has published two papers in reputed journals and has several others currently under review.

Background: Our modern society is increasingly exposed to factors which put individuals in potentially dangerous situations. Injury is an important cause of mortality and morbidity. In the past 15 years, it is the second most common cause of death in the United Arab Emirates (UAE), accounting for more than 1200 deaths annually. This number can be significantly reduced through First aid (FA) education and training. There are few published reports assessing the general population’s knowledge about FA in the Middle East. The aim of this study was to investigate the knowledge and attitude towards first aid in the UAE. Method: Self-administered questionnaires were distributed through a non-probability sampling method over 500 residents across the UAE, aged at least 30 years old. Data collection was conducted between July 20, 2017 and September 20, 2017. Participant’s numbers from each city was proportionate to the population size according to the latest available census. Result: More than half of the population (54.2%) were not sufficiently knowledgeable about basic FA. Only 33.8% took a FA course. Age of the participants, higher education and taking FA courses significantly increased knowledge about basic FA information. 83.7% of the population showed positive attitudes towards FA and were willing to take a FA course in the future. Conclusion: The public need to be more educated about FA and how to manage life-threatening situations. Community-based interventions are vital and must be implemented. A low percentage of individuals have taken FA courses due to the fact that those courses are taken voluntarily by individuals. Our study found a large gap of knowledge among individuals who have not taken a FA course with regards to dealing with life threatening situations. This proves the importance of mandating FA courses to individuals in the community.