Use of a minimally invasive cardiac output monitor to optimise haemodynamics in a patient with mitral valve disease undergoing cerebrovascular surgery

Patients with mitral valve disease undergoing cerebrovascular surgery face increased inherent risks due to their associated cardiac comorbidities. As such, the anaesthetic management of such patients is distinctly challenging. Simultaneous consideration of both the cerebrovascular and underlying cardiac conditions determines key anaesthetic issues, as fluids and vasopressors or inotropes need to be titrated according to haemodynamic variables in order to optimise cerebral blood flow without compromising cardiac function. We report a 45-year old female patient with mild mitral stenosis and moderate-to-severe mitral regurgitation who presented to the Khoula Hospital, Muscat, Oman, in 2016 following a ruptured anterior communicating artery aneurysm requiring urgent surgical intervention. As highlighted in this case, the Volume View EV1000[TM][Edwards Life sciences, Irvine, California, USA] system is a minimially invasive haemodynamic monitor that can help immensely in the perioperative management of such patients

Combination of continuous dexmedetomidine infusion with titrated ultra-low-dose propofol-fentanyl for an awake craniotomy

An awake craniotomy is a continuously evolving technique used for the resection of brain tumours from the eloquent cortex. We report a 29-year-old male patient who presented to the Khoula Hospital, Muscat, Oman, in 2016 with a two month history of headaches and convulsions due to a space-occupying brain lesion in close proximity with the left motor cortex. An awake craniotomy was conducted using a scalp block, continuous dexmedetomidine infusion and a titrated ultra-low-dose of propofol-fentanyl. The patient remained comfortable throughout the procedure and the intraoperative neuropsychological tests, brain mapping and tumour resection were successful. This case report suggests that dexmedetomidine in combination with titrated ultra-low-dose propofolfentanyl are effective options during an awake craniotomy, ensuring optimum sedation, minimal disinhibition and a rapid recovery. To the best of the authors' knowledge, this is the first awake craniotomy conducted successfully in Oman

Early versus late tracheostomy for patients with high and low cervical spinal cord injuries

Objectives: This study aimed to evaluate the effects of early versus late tracheostomies among patients with cervical spinal cord injuries [CSCIs]

Methods: This retrospective study included 69 adult CSCI patients who underwent bedside percutaneous tracheostomies at the Intensive Care Unit of Khoula Hospital, Muscat, Oman, between January 2011 and October 2015. The tracheostomy was considered early if the procedure took place within one week of the CSCI. The impact of an early tracheostomy on patient outcomes was analysed in terms of duration of mechanical ventilation and intensive care unit [ICU] stay among patients with high [C1-C2 vertebrae] and low [C3-C7 vertebrae] CSCIs. Ventilator dependence, bradycardia episodes and surgical intervention outcomes were also examined

Results: Patients with a high CSCI who underwent an early tracheostomy spent significantly fewer days on mechanical ventilation compared to those who underwent a late tracheostomy [9.3 +/- 7.2 days versus 13.7 +/- 3.2 days; P = 0.041]. Low CSCI patients who received an early tracheostomy also experienced significantly fewer days on mechanical ventilation compared to those undergoing a late tracheostomy [12.1 +/- 10.4 days versus 25.2 +/- 17.7 days; P = 0.035]. Moreover, ICU mortality was significantly lower for high CSCI patients who underwent an early tracheostomy [P = 0.015]. However, there was no association between length of ICU stay and either type of CSCI or timing of the tracheostomy procedure

Conclusion: An early tracheostomy is beneficial in reducing the duration of mechanical ventilation among patients with CSCIs, irrespective of the level of injury

Radiofrequency ablation of stellate ganglion in a patient with complex regional pain syndrome

Complex regional pain syndrome [CRPS] is characterized by a combination of sensory, motor, vasomotor, pseudomotor dysfunctions and trophic signs. We describe the use of radiofrequency [RF] ablation of Stellate ganglion [SG] under fluoroscopy, for long-term suppression of sympathetic nervous system, in a patient having CRPS-not otherwise specified. Although the effects of thermal RF neurolysis may be partial or temporary, they may promote better conditions toward rehabilitation. The beneficial effect obtained by the RF neurolysis of SG in this particular patient strongly advocates the use of this mode of therapy in patients with CRPS