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1.
Anesth Analg ; 134(3): 653-660, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34968193

RESUMO

BACKGROUND: Pakistan is a lower middle-income country located in South Asia with a population of nearly 208 million. Sindh is its second largest province. The aim of this survey was to identify the current setup of pediatric services, staffing, equipment, and training infrastructure in the teaching hospitals of Sindh. METHODS: The survey was conducted between June 2018 and September 2018. A questionnaire was designed with input from experts and pretested. One faculty coordinator from each of 12 of the 13 teaching hospitals (7 government and 5 private) completed the form. Information was exported into Statistical Package for the Social Sciences (SPSS) version 22. Frequency and percentages were computed for all variables. Confidentiality was ensured by anonymizing the data. RESULTS: Anesthesia services are provided by consultants with either membership or fellowship in anesthesia of the College of Physicians and Surgeons of Pakistan (CPSP). All drugs on the World Health Organization (WHO) essential medication list were available, although narcotic supply was often inconsistent. Weak areas identified were absence of standardization of practice regarding premedication, preoperative laboratory testing, pain assessment, and management. No national practice guidelines exist. Pulse oximeters and capnometers were available in all private hospitals but in only 86% and 44% of the government hospitals, respectively. Some training centers were not providing the training as outlined by the CPSP criteria. CONCLUSIONS: Several gaps have been identified in the practice and training infrastructure of pediatric anesthesia. There is a need for national guidelines, standardization of protocols, provision of basic equipment, and improved supervision of trainees. One suggestion is to have combined residency programs between private and government hospitals to take advantage of the strengths of both. Recommendations by this group have been shared with all teaching hospitals and training bodies.


Assuntos
Anestesia , Anestesiologia/educação , Anestesiologia/métodos , Hospitais de Ensino/organização & administração , Pediatria/educação , Pediatria/métodos , Centros de Atenção Terciária/organização & administração , Adolescente , Criança , Pré-Escolar , Atenção à Saúde , Guias como Assunto , Hospitais Públicos , Humanos , Lactente , Recém-Nascido , Internato e Residência , Manejo da Dor , Medição da Dor , Paquistão , Padrões de Prática Médica , Pré-Medicação/normas , Encaminhamento e Consulta , Inquéritos e Questionários
2.
J Anaesthesiol Clin Pharmacol ; 32(1): 109-11, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27006554

RESUMO

Airway fires pose a serious risk to surgical patients. Fires during surgery have been reported for many years with flammable anesthetic agents being the main culprits in the past. Association of airway fires with laser surgery is well-recognized, but there are reports of endotracheal tube fires ignited by electrocautery during pharyngeal surgery or tracheostomy or both. This uncommon complication has potentially grave consequences. While airway fires are relatively uncommon occurrences, they are very serious and can often be fatal. Success in preventing such events requires a thorough understanding of the components leading to a fire (fuel, oxidizer, and ignition source), as well as good communication between all members present to appropriately manage the fire and ensure patient safety. We present a case of fire in the airway during routine adenotonsillectomy. We will review the causes, preventive measures, and brief management for airway fires.

3.
J Coll Physicians Surg Pak ; 23(12): 885-7, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24304993

RESUMO

Thyroidectomy is usually performed under general anaesthesia with endotracheal intubation. Bilateral cervical plexus block has been occasionally used as sole anaesthesia technique for this operation in certain parts of world. Indications for regional anaesthesia elsewhere in the world are patient's preference and associated marked cardio-respiratory disease. This is the first report of thyroidectomy done solely under bilateral cervical plexus block in Pakistan. The patient had thyroid cancer and was medically compromised due to cardiac failure with ejection fraction of 25%. Bilateral cervical plexus block was performed to avoid the high risk with general anaesthesia. Total thyroidectomy was done while patient remained painfree during the procedure and top-up local anaesthetic infiltration was not required. Patient remained stable without any morbidity. Positive experience from this case indicates that regional anaesthesia with monitored anaesthesia care is safer than general anaesthesia in high risk patients and could be offered to selective thyroidectomy candidates.


Assuntos
Anestesia por Condução/métodos , Plexo Cervical , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Idoso , Anestesia Geral/métodos , Anestesia Local , Humanos , Masculino , Medição da Dor , Dor Pós-Operatória/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Resultado do Tratamento
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