Day 1 :
Sri Jayewardenepura General Hospital, Sri Lanka
Time : 09:30-09:55
Kanishka Indraratna is Consultant Anaesthesiologist at Sri Jayewardenepura General Hospital, Sri Lanka. He has also worked as a Consultant Anaesthesiologist in England. His interests are cardiac and neuro anesthesia, critical care and intra operative transoesophageal echocardiography. A review article by him on \\\"To give or not to give fluid challenges\\\" was published in Trends in Anesthesia and Critical Care, June 2012.
Peri operative cardiac failure carries a high morbidity and mortality and its occurrence can spell catastrophe for allrnconcerned. Peri operative cardiac failure can occur due to decompensation of existing cardiac dysfunction, acute ischaemicevent, or overloading of fl uid or an increase in the aft erload. During anaesthesia any of these can occur particularly if the heart function is already compromised. It may occur due to myocardial depression, an imbalance in the coronary oxygenrnsupply, inappropriate transfusion of fl uid or vasoconstriction. Th e traditional methods used for evaluating optimum cardiacfunction intra and peri operatively were measurements such as the cvp and pcwp whose value has been questioned. To preventrnand manage peri operative heart failure , there should be methods of assessing cardiac function and to monitor whetherrntherapeutic manipulations have the desired eff etc. It is important to monitor the volume status, whether giving fl uid challengesrnis safe, whether the contractility of the myocardium is satisfactory, whether it is deteriorating, whether it needs inotropes. Isthe heart dilated, and does it need to be overloaded? Would a vasoconstrictor or vasodilator help. Th is presentation , shows how transoesophageal echocardiography can be used to obtain this required information and thereby help in preventing andmanaging peri operative cardiac failure.
Dokuz Eylül University School of Medicine,Turkey
Time : 09:55-10:20
Ayse Karci has completed her medical education at Ege University, Turkey and was specialized in Anesthesiology in Dokuz Eylul University School of Medicine. She is still working in the same hospital as an Associate Professor. She has worked in the Department of Obstetrics and Labor Unit as Anesthesiologist and was also the Director of School of Anesthesia Technicians for six years. She has 16 publications in reputed journals and 29 Turkish papers in the field of Anesthesia.
Perfusion index as a predictor of successful neuraxial anesthesiarnAyse KarcirnDokuz Eylul University, Turkeyrnrn Abstractrnrn Background & Aim: Traditionally evaluation of adequacy of the neuraxial anesthesia depends on the loss of response to the sensations of cold and pinprick which requires patient cooperation. Objective assessment of clinical signs of sympathectomy do not appear fast enough to confirm surgical anesthesia. We hypothesized that increases in the pulse oximeter perfusion index (PI) may provide earlier and clearer objective evidence for sympathectomy compared to traditional responsed to sensory stimulation. rnrnMaterials & Methods: After approval was obtained from the Ethics Committee of University of Dokuz Eylül, Medical School, İzmir, patients between 18-65 years of age who were categorized as American Society of Anesthesiology physical status I-III were included. A spinal block using 0.5% bupivacaine was performed with the patient in the sitting position. No external heating device was used. The upper sensory block level was checked 2 min after the spinal injection by assessing the loss of cold sensation from alcohol swabs. Systolic blood pressure (SAP), heart rate and PI were recorded at 2 min intervals in the first 10 min and then at 5 min intervals. Skin temperature was recorded at the same times. The PI value is generated by pulse oximetry placed on the second toe. rnrnResults & Discussion: Compared to basal values, sympathectomy caused a significant decrease in SAP and an increase in PI values following spinal anesthesia. The incresase in skin temperature was significant after the 8th min. The increase in the PI value and sensory block level were parallel in 15 min following spinal anesthesia and both stayed at a plateau afterwards. In one patient in whom the spinal block was not successful, PI did not significantly change compared to baseline. rn