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

Nizar has completed his Medical School at the University of Bologna in Italy in 2006, In 2014 after compelting his training in thoracic surgery Nizar moved to London and worked in the most important hospitals for thoracic surgery in UK: Royal Brompton Hospital, Great Ormond Street Hospital and Harefield Hospital. In 2017 Nizar was appointed as a consultant in thoracic surgery at Harefield Hospital, one of the most important Hospitals for cradiothoracic and transplantation in UK and in Europe. Nizar is specialised in minimal invasive surgery and performs most of the operation with VATS techniques. Nizar has presented in more than 50 national and international conferences presenting several researches and lectures and published more than 30 papers; he is researcher and currently leading multiple projects in thoracic surgery.

Introduction: Thoracic epidural analgesia (TEA) is considered the gold standard in patients undergoing thoracotomy; however, paravertebral block (PVB) is considered a valid alternative with lower incidence of side effects. With the increase of minimal invasive thoracic surgery and introducing the enhance recovery after surgery, PVB becomes the first choice of analgesia. We present our results of differnet analgesia techniques in patient underwent thoracotomy in one of the largiest hospital for thoracic surgery in London, UK.

 

Method: Patients underwent thoracotomy from March 2016 to March 2017 were prospectively reviewed and categorized based on analgesia techniques: Epidural with local Anesthetic (LA) and opioid, Epidural with only LA with addition patient controlled analgesia (PCA), paravertebral block (PVB) with PCA. We analysed the pain control, complications and length of stay.

 

Result: 137 patients underwent thoracotomy; 54 had thoracic epidural with LA and opioid, 32 epidural with LA with additional PCA and 52 PVB with additional PCA. There was no significance difference between the three groups in sex, age and weight.

There was no significant difference between the three groups in the pain score immediately after surgery (P=0.41); however,there was no significance difference between the three groups in the pain score in the first 24 hours (P=0.024). Interestingly there was no significant difference between the three groups in complications: Nausea, vomiting, urinary retention and constipation.

 

Conclusion: PVB is a valid alternative for TEA in patients undergoing thoracotomy. However, considering the increase minimal invasive surgery techniques in thoracic surgery, PVB should be the first choice to promote the enhance recovery after surgery.

Award winning experienced physician specialized in Paediatric Anaesthesiology, Critical care & amp Pain medicine. Serving in tertiary care teaching military

hospitals in Bangladesh. Participated in United Nations peace-keeping missions in Liberia & Western Sahara as Anesthesiologist provided anesthesia

services and intensive care to lot of war-injured distressed African patients.

Geographically Bangladesh is located in an area where natural calamities like flood, cyclone, and drought are very common. The country is hugely populated (1252/Sq km) due to its livable plain terrain with good reserve of natural resources but as usual we have a developing health management system. So, as a non-earning member of family women and children is most vulnerable group of society. Children constitute more than one third (51.3 million) of total population on the other hand woman constitute almost half (49.40%) as well. Due to low GDP, allocation of budget in health (0.92% of GDP) specifically for addressing children and maternal health is not sufficient. Despite diversity in their geographical, linguistic, and political structures, Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka face common health challenges. Moreover socioeconomic status of these countries differs very little. Even though Bangladesh has achieved United Nations Award for successful reduction of infant (28.2/1000) and maternal mortality rate (170/1000) on MDG 4 during the 65th UNGA. Presently working in a1500 bedded tertiary care teaching hospital which has 30 bedded paediatric surgery ward, 130 bedded paediatric medical ward, 10 bedded neonatal ICU,10 bedded paediatric ICU and 36 bedded adult ICU as well. We are performing on an average 100 routine pediatric surgery cases every month. Amongst those common surgical diseases are hernia, ARM, hirschsprung’s disease, tongue tie, appendicitis, intussusceptions, rectal polyp, IHPS, hydrocephalus, hypospadias

etc and less common surgical diseases are esophageal atresia with/without fistula, intestinal atresia, eventration of diaphragm, diaphragmatic hernia, mesenteric cyst, myelomeningocele, PUV,UDT, gastroschisis, omphalocele etc. The hospital is rich with allied health professionals in almost all discipline specially paediatric cardiology, paediatric cardiac surgery. We have enough

hospital bed and plenty patients but having limited number of skill doctors & paramedics. We are turning over maximum number of patients with minimum resources and staffs. We have lot of concerns like capacity building, poor socioeconomic and poor nutritional states, inadequate social awareness programs, delayed reporting sick to hospital & delayed interventions, extreme resources constrains etc and to combat those challenges we do few improvisations like improvised way of maintaining airway, improvisation of warming patients, fluids, blood etc, clinical monitoring of patients instead of sophisticated electronic monitoring devices.

Soha Talaat is an Assistant fellow of anesthesia at National heart institute, Egypt and Anesthesia registrar at Quttainah Medical Center, Kuwait. She is the Professor of anesthesia and pain, in Alexandria University and head of Anesthesia department at Quttainah Medical Center, Kuwait.

Background: Raynaud’s phenomenon is a disorder of microvasculature affecting fingers and toes as a result of vasoconstriction of digital arteries. It is further divided into primary and secondary Raynaud’s phrnomenon. Secondary Raynaud’s is often related to connective tissue disorders. The hallmark of Raynaud’s phenomenon is ischemia of the digits in response to cold which produces a characteristic triphasic color pattern.If the vasospasm is severe and long lasting, the attack may lead to critical ischemia and gangrene of the digits. Though pathophysiology of Raynaud’s phenomenon is not well understood, systemic and local vascular effects are mostly associated with primary Raynaud’s disease.

 

Case presentation: We report the case of a 36 year old Kuwaiti female patient with SLE and Raynaud’s phenomenon who underwent liposuction under general anesthesia. She went to Germany where she was treated with Imuran 50mg OD. Plaquenil 200mg OD, baby ASA and sildenafil 20mg OD. Her lupus responded well to medication. She is not on steroid and cleared of all medications except Plaquenil 200 mg OD for the past 6 months. All her investigations were normal. She gave history of very short episodes of blanching of the hands that resolved instantaneously. Preoperative preparation included increasing operating room temperature, fluid warmers and warming blankets. Induction of anesthesia was done with Remifentanil 1ug. kg-1, propofol 200mg and rocuronium 50mg. Airway was secured with armored tube size 7.5. Anesthesia maintained with O2/N2O mixture in 2% sevoflurane with low flow and remifentanil infusion 0.012mg.kg-1.hr -1. Operation started and warm irrigation fluid of normal saline 0.9% and adrenaline in the concentration of 1:1,000,000 were infiltrated subcutaneous and liposuction started. After 2 hours the displayed waveform and numerical values of SpO2 disappeared suddenly. We double checked ventilator and patient. Bilateral air entry was auscultation and end-tidal CO2 the same and all hemodynamics were normal. Operation  was aborted and patient recovered but still with vasospasm of periphery that resolved later in recovery within 2 hours. Her Rheumatologist was consulted and advised to give nifedipine retard 20mg twice daily.

Conclusion: Inspite of taking all precautions and warming patient and fluids patient underwent a prolonged attack of Raynaud’s phenomenon. Adrenaline and vasoconstrictors contraindicated in Raynaud’s patients and in general they are not eligible candidates for liposuction

Khoisnam Dhananjay Singh has completed his Medical School at the University of Nagpur in 1982, 1988 after completing his training in MBBS Dr. Singh moved to Punjab University to complete education and worked in the most important hospitals for pain management in St. Thomas’s Hospital London. In 2003 he completed postgraduate in the Institute of Health care Administration, India. Nizar is specialised in Anaesthetist and pain management Burjeel Royal Hospital, Al Ain, UAE

The environmental impact by an aesthetics gas inside and outside of operating theatres has been of concern in the recent time. Greenhouse gas emissions were estimated using activity data and emission factors and reported according to the Greenhouse Gas Protocol adapted to define emissions. The environmental impact of operating theatres in three academic centers in Canada, the United States, and the United Kingdom over a 1-yr period in 2011. Greenhouse estimate the carbon footprint of surgery in the three centers at 9.7 million tons of carbon dioxide emitted per year.

Adaptation of TIVA( Total Intravenous Anesthesia) has promising result

This lecture would summarize

1. Anesthetics and patients’ environment

2. Anesthetics and health workers

3. Anesthetics and environment -contribution to Global warming

4. Adaptation of TIVA

Undergraduate training: Diploma in Medicine and General Surgery, MD Slovakia; 1997. Postgraduate qualifications and fellowships: Fellowship of the Royal College of Anaesthetists; UK (FRCA). Slovakian Board in Anaesthesia and Intensive Care Medicine. Membership of the academy of medical educators (MAcadMEd). Teaching activities: Senior university lecturer university of Manchester, medical school. Lead of examination for fourth year medical school; university of Manchester. Academic advisor. Member of the north school of anaesthesia interview panel. Management responsibilities: Previous Clinical Director of The Day Surgery Unit at Salford Royal Hospital NHS Trust, University Teaching Hospital. Expert in: Awake craniotomies.Neuro anaesthesia and anaesthesia for major spinal surgery. Anaesthesia and pain management for colorectal surgeries; laparotomy and Laparoscopy. ERAS protocol for orthopaedics surgery. Upper GI surgery.

Objective: To improve acute postoperative pain management by introducing a new protocol: Postoperative Intravenous Lidocaine Infusion (IVLI).

Design and Setting: A Quality Improvement (QI) report conducted within the Anesthetic department at Salford Royal Foundation Trust (SRFT)

Method: Current SRFT protocols on perioperative IVLI and postoperative analgesia were reviewed. A systematic literature review was conducted on PubMed database for articles exploring the efficacy of postoperative IVLI published within the past ten years. These were used as the foundation of a new postoperative IVLI protocol.

Result: Ten papers were identified from the literature review. Postoperative IVLI was shown to reduce postoperative pain, opioid consumption, nausea and vomiting and postoperative gastric ileus in three meta-analyses, two systematic reviews and one randomised controlled trial.

Conclusion: This QI report has highlighted postoperative IVLI as an effective and safe method of pain management following surgery. A proposed protocol for postoperative IVLI was developed. Acute postoperative pain management can be further improved from the current protocols.

Aislinn Killian completed her bachelor of surgery in Royal College of Surgeons Ireland in 2017. Killian has experience in the field of General Surgery, Psychiatry, Emergency Medicine, and Gastroenterology. Currently Aislinn is working on a systematic review and retrospective study on data from Cleveland Clinic Abu Dhabi, UAE

Importance: Better haemodynamic control for patients with acute ischaemic stoke is associated with improved neurological outcomes. To date there is not sufficient evidence as to whether receiving general Anesthesia or procedural sedation during thrombectomy allows for better haemodynamic control and if this has a subsequent impact on early neurological improvement.

 

Objective: To assess whether procedural sedation is superior to general anesthesia for haemodynamic control and early neurological improvement among patients receiving stroke thrombectomy.

 

Design, Setting, and Participants: This paper will have a two part design. First a literature review and meta-analysis will be done to analyse the existing evidence. Secondly a retrospective study of 150 patients with acute ischemic stroke in who received thrombectomy in CCAD will be completed.

 

Outcomes: The primary outcome measures will be range in mean arterial pressure during thrombectomy and NIHSS after 24 hours, at discharge and after 3 months. Secondary outcome measures will be range in systolic blood pressure, episodes of desaturation, mortality, length of hospital stay, modified rankin scale at discharge and at 3 months, and complications intraoperatively

and in the recovery room.

 

Conclusion: The aims of this study are to retrospectively clarify whether general Anesthesia or procedural sedation allow for better haemodynamic control during thrombectomy and if this is associated with better early neurological outcomes.

Vicki Morton is currently the Director of Clinical and Quality Outcomes at Providence Anesthesiology Associates in Charlotte, NC where she is responsible for the management and expansion of the Enhanced Recovery After Surgery (ERAS) program to include 6 facilities within a hospital system and 6 service lines.

She attended Queens University of Charlotte for her BSN and later attended the Medical University of South Carolina for her Masters in Nursing and Doctorate

in Nursing Practice. She is a board-certified Adult Nurse Practitioner. Vicki worked as a critical care nurse for 15 years before leaving the bedside to pursue her advanced degrees.

Surgery has become a gateway which has lent to the current opioid epidemic in the United States. New persistent opioid use following surgery is not uncommon regardless of major or minor surgery, particularly in the opioid naïve patient. Each year, 56 million patients receive opioids following surgery and approximately 3 million of those patients will become new, persistent users of opioids. Considering this staggering problem, efforts to reduce perioperative opioid consumption should become a focus within healthcare. Our objective was to implement multimodal analgesia as part of an Enhanced Recovery Pathway (ERP) in colorectal, bariatric, urology, and gynecology surgeries in effort to reduce the consumption of opioids in all phases of perioperative care while improving patient satisfaction. Multimodal analgesia was implemented in 456 colorectal, 381 bariatric, 62 gynecologic, and 45 urologic adult surgical patients at a non-academic institution. Opioid consumption was measured in all phases of operative care and compared to retrospective matched controls. Perioperative multimodal analgesia, including transversus abdominis plane (TAP) blocks was implemented. The ERP cohort demonstrated reduced opioid usage in all phases of care: 18% (intraoperative), 25% (PACU), and 52% (floor) of patients did not need opioids (p=<0.001). The overall intraoperative average fentanyl dose reduced from 210 mcg in the pre-ERP cohort to 72 mcg in the ERP cohort (p=<0.001). Overall PACU averages for fentanyl and dilaudid doses decreased from 154 mcg to 99 mcg and 1.7 mg to 0.97 mg respectively (p=<0.001). Lastly, overall (floor) oxycodone and dilaudid dosages reduced from 40 mg to 14 mg and 3.7 mg to 0.92 mg (p=<0.001) respectively. The mean maximum pain score at 2 hours postop reduced from 8.2 to 4.7.

Hany Mohamed Elzahaby is the Professor and Head of Anesthesia, Intensive Care and Pain Management Department, Ain Shams University, Egypt. His

Achievements include: Head of Pediatric Anesthesia Unit, Ain Shams University, 2010-2018, Specialist Registered in Anesthesia, United Kingdom 2007, Consultant Anesthetist, North West Armed Forces Hospital, Kingdom Of Saudi Arabia 1999-2007, Degree of Doctor in Anesthesia, Ain Shams University, 1994, Fellowship in Anesthesia, University of Iowa, United States of America 1992-1994, Master Degree in Anesthesia, Ain Shams University, 1989, Bachelor Degree in Medicine and Surgery, Ain Shams University.

The Micropremies are preterm neonates is borne before 30 gestational weeks and have extremely low birth weight infants (<1000 g). Morbidity and mortality in this population has decreased over the past decades and general anesthesia is increasingly needed for surgical and diagnostic procedures. Knowing their unique physiological features is necessary. Common complications of prematurity include: postoperative apnea, broncho-pulmonary dysplasia, patent ductus arteriosus (PDA), right to left shunt, intraventricular hemorrhage, long term cognitive impairment, retinopathy of prematurity, altered temperature regulation with impaired renal and metabolic functions. The debate continues upon who should provide the care and where to do these cases. Preoperative preparation focuses on optimization of cardiac and respiratory status and on treatment of anemia, electrolyte abnormalities, metabolic acidosis and coagulopathy. There are 2 common scenarios, the first is a relatively stable micropremie with a secured IV access coming for ligation of PDA where a high dose fentanyl and a relaxant will do the job. The second scenario is an unstable micropremie with difficult venous access, hypothermic,

hemodynamically unstable with coagulopathy and thrombocytopenia coming for laparotomy for NEC. Management differs if they are on conventional ventilation or on HFOV. Permissive hypercarbia is common in NICU setting. The decision to conventionally or manually ventilate them is critial as they usually go hypocapnic and hypocalcemic that may be detrimental to their myocardium.

Common problems are hypotension and hypovolenia, hypothetmia, hypocapnia and hypocalcemia.

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.

Fouz Alzahrani has completed her master degree of human resource management at the age of 33 years from Alyamamah university. With 6 years’ of experience

as anesthesia technologist at KFSHRC Riyadh. She has researched about 2030 Saudi vision implementation among health care practitioners. She designed

special KPIs specifically applicable for anesthesia technologist.

Successful organizations that concerned of quality of work environment have implemented many efforts for integrating employee customer and shareholders values. In this framework, research shows that employee engagement has positive effect on productivity and attitude of employees more than intrinsic motivation, satisfaction and recognition. This research paper about designed CPR engagement program, Researchers aimed to find the reasons behind disengaged health care practitioners by interviewing the respondents, comparing the facts with another role model, and by reviewing the research conducted by expertise. Then were able to summaries the facts scientifically and design a unique engagement program fit for doctors’ nurse’s and allied health practitioners who are working in high loaded work environment. The idea comes with recommendations that going to success the engagement project. This research is conceptual in nature that they target to have complete vision about engagement effect on employees’ patients and organizations. And how to synchronize the engagement benefits for busy employee who are not able to attend the engagement activities outside work place. Present the information in designed form fit for non-managerial audiences to reach the target from such topic which is health career development.

After completing her undergraduate degree in Poland, Dr. Steiner earned her medical degree at the Medical University of Warsaw where she was named junior lecturer in the Department of Human Anatomy and Biochemistry; then completed an internship at the Postgraduate Medical Center of The Military Medical School. She completed a residency in general surgery at the Cabrini Medical Center in New York City, and a residency in anesthesiology and a fellowship in pain

management at New York University Medical Center. Dr. Steiner is past faculty at the University of California San Diego and Harvard Medical Faculty Physicians

Over 80% of the population will suffer from lower back pain during their lives, it is the fifth most common reason for all physician visits in the US. Most cases of lower back pain can be linked to a general cause—such as muscle strain, injury, or overuse—or can be attributed to a specific condition of the spine, most commonly: Herniated Disc, Degenerative Disc Disease, Spondylolisthesis, Spinal Stenosis, Osteoarthritis. A number of less common conditions can cause low back pain as well, such as sacroiliac joint dysfunction, spinal tumors, fibromyalgia, and piriformis syndrome. Patients with back pain radiating to the leg(s) report worse symptoms and poorer recovery than those with back pain alone. In primary care, approximately 60 % of patients presenting with low back pain (LBP) also report pain in the leg(s). Leg pain associated with LBP is generally considered to be either referred or radicular pain. The latter is commonly labelled sciatica and is often characterized by pain radiating to below the knee, into the foot and toes, and may be accompanied by objective findings of nerve root entrapment such as sensory deficits, reflex changes or muscle weakness. The most common reasons for sciatica are a disc bulge/prolapse or stenosis (either of the central canal or the foramen) impinging or irritating a nerve root(s). Referred leg pain from the low back is unrelated to nerve root involvement and is considered as pain referred from any other structure such as muscle, ligament, joint or intervertebral disc. It is generally acknowledged that the differentiation between sciatica and referred leg pain is not always straightforward in clinical practice, but ultimately it is a clinical diagnosis. Overall, patients who complain of back and leg pain and/or sciatica suffer more severe pain and disability, take longer to recover and incur most of the indirect costs and lost workdays compared to those with back pain alone. When determining the underlying cause of lower back and lower extremity pain, both the type (a description of how the pain feels) and the area of pain distribution (where the pain is felt) help

guide the physician in making a preliminary diagnosis and determining the appropriate treatment plan.

It has been more than Teen years since Mr. Ahmed Ayoub have become an official healthcare provider. He finished his Bachelor’s Degree from Philadelphia University in Jordan 2009. Eventually he proceeds to Study Master’s in Oncology Nursing from Hashemite University in 2013. He has an impressive work experience as a Senior Charge Nurse at King Hussein Cancer Center, Jordan in Medical/Surgical/VIP/OPD. He is currently working now in Al Dhafra Hospitals (Madinate Zayed Hospital) / SEHA United Arab Emirates as Outpatient Staff Nurse for more than three years. Mr. Ahmed Ayoub is a Champion of Nursing Research in Al Dhafra Hospitals and follows up around 9 hospitals. He has published 4 papers entitled: Do Not Resuscitate: An Argumentative Essay, Distributed in Ethics eJournal Vol 6, Issue 81, May 14, 2013. Consent Form Analysis, Distributed in Health Care Law & Policy eJournal Vol 5, Issue 20, April 08, 2013. The Effectiveness of Initial Assessment on Pressure Ulcer Prevention among Adult Jordanian Cancer Patients, Under Review. Assessment of Nurse’s Knowledge about Glasgow Coma Scale at Al Dhafra Hospitals, Abu Dhabi, United Arab Emirates. Journal of Clinical Review & Case ReportsVol3, Issue7, 01 Sep 2018.

Cancer is a worldwide health problem. In Jordan, cancer is the second leading cause of death. Approximately 2000 people die from cancer every year, 70% of them experiencing varying high levels of pain due to ineffective pain relief. This study aims to identify the attitudinal barriers to effective cancer pain relief in patients and their family caregivers in Jordan. A cross-sectional questionnaire survey was used. A convenience sample of 300 cancer patients and 246 family caregivers were recruited from 4 different Jordanian hospitals between August 2009 and May 2010. Patients completed the Arabic version of

the Barriers Questionnaire II (ABQ-II), the Arabic Brief Pain Inventory (A-BPI) and a demographic questionnaire. Family caregivers completed the ABQ-II and a demographic questionnaire. The A-BPI results identified that over 70% of cancer patients in localized stage and over 90% of the patients with advanced cancer experienced substantial pain. Four major barriers to pain control were highlighted: fears related to addiction, side-effects, communication concerns and fatalistic beliefs. This study contributes to provide baseline information about the barriers to effective cancer pain control in Jordan.