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.