11^th International Conference on Anesthesiology and Critical Care November 15-16, 2018 Dubai, UAE

Biography:

Husham Al-Shather is a consultant in pain medicine and anaesthesia. He specialises in the management of chronic pain conditions. He provides a variety of
interventional and non-interventional treatments for this specific patient population. Husham is a Fellow of the Faculty of Pain Medicine of the Royal College of
Anaesthetists and a Fellow of the Royal College of Anaesthetists. Since he joined The Royal Berkshire NHS Foundation Trust as a consultant in Pain Management
and Anaesthetics in 2016, he has developed a very good reputation in providing patients with optimal clinical care and scored highly for rating of clinical effectiveness
and patient satisfaction. This has been gained by working in a robust multidisciplinary team which emphasises the use of proven and evidence based medicine.

Abstract:

Background: Intravenous Lidociane Infusion Protocol (ILIP) for Chronic Pain Conditions in Royal Berkshire NHS Foundation
Trust was introduced in 2008. This protocol was set to provide a safe environment as well as ensuring that patients always
receive best possible care at the right time.
Objectives: In this audit, we aimed to measure the compliance with the ILIP and to determine the clinical outcome of ILIP in
Chronic Pain Conditions that are not responding to conventional treatments.
Methods: After departmental and Hospital approval, we undertook a retrospective analysis of 100 patients who underwent
two or more intravenous Lidociane infusion between March and November 2017. We looked at the patients’ demographics,
indication of Lidociane infusion, dose of Lidociane, duration of procedure, possible side effects and complications after
intravenous Lidociane. Post-procedure outcomes including patients’ experience and overall value of care were also collected.
Results: The average patient age was 48 years. 87% of patients were females and 13% were males. Non-invasive monitoring
(ECG, BP, SPO2 and Temperature) was performed in 100% of cases. Lidociane (2%) was used in all patients, with an average
dose of 4.8 mg/kg. The average length of procedure was 68.5 minutes. During the procedure, intravenous Plasma-Lyte 148 (pH
7.4) solution was used in all cases. The majority of patients had Fibromyalgia or Widespread Pain (81/100). 100% of infusions
were performed by Consultant Pain Specialist and fully trained Specialist Nurses supervised all procedures. 82% of patients
had no complication or side effect. The most common side effects were generalised numbness and tingling sensation (12%).
There was no significant side effect or complication documented during or after the infusion.
Conclusions: Most of intravenous Lidocaine infusion protocol elements for chronic pain conditions were being followed
appropriately. Our audit demonstrated that adherence to ILIP for a chronic pain condition was associated with significant
satisfaction among patients and staff with minimal side effects.

Biography:

Abstract:

Anxieties, fear of unknown and new environment are significant determinants of pre-operative agitation in children undergoing surgery and manifesting as tearfulness, screaming, clinging to parents, apathy, and withdrawal. If not properly handled, its presence is associated with future maladaptive behaviour. The incidence of preoperative distress maybe as high as
60% leading to resisting the anesthesiologist at induction or violent behaviour at the time of shifting and induction of anesthesia. 60% of children who underwent anesthesia manifest negative behavioural changes up-to two weeks postoperatively while min 20% of cases these may continue for six months. Apart from undesirable effects of sympathetic tone and increased level of catecholamine secondary to stress response, immunological, metabolic and hormonal changes also occur. Studies have demonstrated the relationship between preoperative anxiety and emergence delirium, increased analgesic requirements, negative behavioural changes, sleep disturbances and separation anxiety in the post-operative period.

Uses of pharmacological or non-pharmacological modalities are commonly utilized to decrease preoperative anxiety. Nonpharmacological therapies though effective, have variable results. Sedative premedicants are the mainstay of pharmacological therapy though different agents and routes of administration have been tried. Nonparental routes like oral/trans mucosal are preferred in children to alleviate the needle fear and pain. Midazolam has attained a widespread acceptance as preoperative sedative and anxiolytic. Use of drugs with pharmacological effects other than benzodiazepines have been tried and found to Have favourable kinetics. Use of α 2 agonist clonidine and Dexmedetomidine have been tried and found to have comparable results. Melatonin a natural hormone produced in the brain has the properties of producing natural sleep and has been used as sedatives in elderly and children Newer sedative premedicants like melatonin, clonidine, and Dexmedetomidine are efficacious in producing preoperative sedation, reducing preoperative distressing anxiety, relieving postoperative pain and decreasing the occurrence of emergence delirium in pediatric patients undergoing surgery. These agents can be used safely as an alternative to midazolam for premedication in children.

Biography:

Badri Prasad Das has completed MD in Anesthesia and critical care in 2015 from IMS, Banaras Hindu University (BHU), Varanasi; has pursued postgraduate fellowship
in Critical Care medicine from Trauma Centre, BHU(Varanasi), Neuro Critical Care from NIMHANS(Bengaluru) and CCM from JIPMER(Puducherry).
At present, he is working as Assistant Professor in Anaesthesia and Critical Care, IMS-BHU, Varanasi. He is an instructor for AHA (BLS/ACLS/PALS), FCCS;
programme coordinator for Comprehensive Emergency Life Support (CELS) course; and an invited faculty in various regional/national workshops & conferences.
He has published more than 10 papers in reputed journals, been serving as a reviewer for various International journals (HPMIJ-Medcrave), has many national/
international awards including education-grant awards from ANZICS.

Abstract:

The recent Brain Trauma Foundation guidelines did not carry forward its earlier recommendations on osmotherapy in severe traumatic brain injury (TBI) because of insufficient high-quality evidence from comparative studies. HTS is no more advantageous than mannitol in maintaining hyperosmolar state and controlling ICP, which might be due to urinary sodium loss, which curtails its superior osmolar effect. We did a study to explore the impact of tolvaptan when added to HTS on osmolar efficacy in such patients. A single-centric, prospective, double-blind, investigator-initiated clinical comparative trial was conducted between June 2017-June 2018 at Trauma ICU,IMS-BHU,Varanasi, in which 76 adult patients with severe TBI belonging to age group 15-70 years, receiving aliquots of 2.5ml/kg of 3%HTS for refractory-ICH, were randomized to receive tolvaptan (Group A) or placebo(Group B) to achieve target ICP <22 mmHg and CPP >60mmHg. Addition of tolvaptan increased serum sodium and osmolality significantly in a sustained manner throughout the study period(p=0.03 and 0.02, respectively), which translated into better ICP control with lesser boluses of HTS(p=0.01). The outcome parameters (duration of hospital stay 22 ± 10 vs 42 ± 11 days; p=0.04) and unfavourable GOS (GOS=1 to 3) at 6 months (10/40 vs 18/36;p=0.02) and mortality at 6 months (8/40 vs 14/36;p=0.03) were better with tolvaptan use. Here we describe how we manage severe TBI patients in our high-volume trauma center, with use of tolvaptan which not only curtails the effect of urinary sodium loss, thereby increasing the osmolar efficacy of HTS but also leads to better ICP control in severe TBI, translating into better GOS with a mortality benefit.

Biography:

Abstract:

This workshop provides formal didactics, hands-on training and discussions to provide a full understanding of the role
of spine injection techniques. Upon completion of the workshop, participants will learn strategies to Explain the role of
advanced pain procedures in the evaluation and treatment of spine pain. Be familiar with how ultrasound guidance may be used
in performing spinal injections and its limitations. Summarize the role of each injection in the overall care and rehabilitation of
the spine patient. Describe contraindications to the performance of the procedure. Recognize the potential complications associated
with each procedure. Demonstrate anatomy, sonoanatomy and safe radiological principles involved in each injection. Illustrate
the safe and easy technique of spine injection. Demonstrate technical parameters in the performance of each procedure. Learn
injection techniques in epidural space (caudal, lumbar, thoracic, cervical), medial branch block (lumbar, thoracic, cervical) and
peri-radicular block (lumbar, thoracic, cervical)

Biography:

Nagi Amer is a consultant anesthetist and ICU haad license d3953 and has additional specialization in interventional pain ultrasound-guided treatment. He worked as a HOD of anesthesia, ICU and pain in medeor h in an ad and al Raha h in the ad. He has international publications in the related field.

Abstract:

The target of the present study is dual. First, to test the hypothesis of combined nerve block addressing different sites of
nerve course can result in more successful distribution and prolongation of block whenever lower concentration local
an anesthetic mixture is used. Secondly to compare combined Adductor Canal and i-PAK Blocks versus Combined Adductor
Canal and Periarticular Injection Blocks For ACL Reconstruction Surgery
Material and methods: The study is a Prospective, randomized cohort study: After IRB (Institutional Review Board) and
committee approval was obtained, Patients aged 18-75 years undergoing ACL Reconstruction Surgery over the period of
one year and included 246 patients which were randomly allocated to either Combined Adductor Canal and i-PAK Blocks Is
(group A), or Combined Adductor Canal and Periarticular Injection Blocks (group B) groups, each had 123 patients at the end
of the study. Informed consent for this study was taken from the patient. This is a scientific abstract with no patient protected
health information. A standard local anesthetic mixture was used throughout the study. The mixture of Ropivacaine 3.75%
with 4 mg of dexamethasone in a total volume of 42 ml of mixture. There are no off-label indications included. No promotional
the content of a commercial entity is included (brand/trade/product names, photos, logos, company names, etc.).
Results: This the study of the U/S guided comparison of combined Adductor Canal and i-PAK Blocks versus Combined Adductor
Canal and Periarticular Injection Blocks For ACL Reconstruction Surgery demonstrates that of combined Adductor Canal and
i-PAK Blocks results in prolongation of the time before the request for first analgesia rescue (h) (statistically significant) indicated
by higher readings in group A compared to group B. Highly signifi cant diff erence was also observed comparing the two groups
concerning the total pethidine consumption (mg) in the first 48 postoperative hours with much reduction of the total dose in
group A together compared to group B. Postoperative VAPS at rest and on walking were reduced after of combined Adductor
Canal and i-PAK Blocks at all-time points assessed compared to group B.
Discussion: The combination of distal blocks is having the advantage of being safer approach away from critical structures
and allow preservation of proximal muscle function. The inability to move due to the motor block of proximal and distal
musculature has been shown to decrease patient satisfaction. Distal peripheral nerve blocks are superior at preserving the motor
function of the operative limb. A recent randomized controlled trial addressing this subject in the upper extremity (comparing
ultrasound-guided supraclavicular plexus block with distal peripheral nerve blocks for outpatient hand surgery) Showed
better strength preservation and greater patient satisfaction with distal blocks. Using multiple points of blocking the nerves
to reach the sensory terminals supplying the knee region with motor sparing effect can be achieved using lower anesthetic
concentrations. Moreover, combined nerve block addressing different sites of nerve course targeting those which are mainly
sensory can result in more successful analgesia and sparing of motor branches of mixed nerves. The validation of the present
study results essentially requires further large RCT of adequate sample size. The best approach should be tailored to suit specific
surgery whenever possible. This study reiterates the importance of tackling multimodal approach in regional techniques which
probably will have a place in tailoring patient and surgical pain relief needs. Combined Adductor Canal and i-PAK Blocks is
better than Combined Adductor Canal and Periarticular Injection Blocks for For ACL Reconstruction Surgery concerning
postoperative pain.

Biography:

Abstract:

Background And Objectives: Postoperative pain is a major cause of perioperative morbidity and functional impairment.
Preemptive analgesia is an analgesia regimen instituted before the surgery, with an aim to desensitize the pain pathways and
thus, reduce postoperative pain. Pregabalin and gabapentin have been claimed to be effective in reducing the magnitude of
postoperative pain, without significant alterations in hemodynamics. This study was conducted to compare the effectiveness
of Pregabalin and gabapentin in reducing postoperative pain, total opioid consumption, postoperative nausea and vomiting
(PONV) and sedation in patients undergoing lower limb orthopedic surgeries under spinal anesthesia.
Methods: Eighty patients undergoing lower limb orthopedic surgeries under spinal anesthesia were randomly divided into two
equal groups. Group A received 300mg gabapentin and Group B received 150mg Pregabalin, approximately one hour before
surgery. The patients were evaluated at 1, 2, 6, 12 and 24 h postoperatively and Visual Analogue Scale (VAS) score for pain,
PONV and sedation score was monitored. Tramadol 50 mg IV was used as the rescue analgesic and total consumption over 24
hours was recorded.
Results: The mean duration of postoperative analgesia was significantly higher in Group B (282±106 mins versus 234 ±
97mins, p=0.009). The sedation score was significantly higher in Group B in the first hour after surgery (p=0.001). The total
consumption of tramadol over 24 hours was higher in Group A; however, it was statistically insignificant. The occurrence of
PONV was comparable between the groups. None of the groups were associated with significant hemodynamic alterations.
Minor adverse effects such as dizziness, sedation, and headache were observed in both groups.
Conclusion: Pregabalin 150 mg orally significantly increases the duration of postoperative analgesia than gabapentin 300mg
following lower limb orthopedic surgeries under spinal anesthesia. Although sedation is frequently observed, it doesn’t alter
the hemodynamics and thus, may be used safely.

Biography:

Iram Mir is a Postgraduate in Anesthesia and Critical Care from the University of Kashmir in 2005. Worked in Kuwait from 2008- 2014, Specialist in Intensive Care Rashid hospital and Trauma hospital Dubai since November 2015.

Abstract:

Acute Kidney Injury is estimated to occur in about 20-200 per million populations in the community, 7-18% of patients
in the hospital and approximately 50% of patients admitted to the ICU. AKI is associated with short and long-term
complication, with development of CKD and ESRD and increase mortality and morbidity leading to high fi nancial health
care costs and burden. Estimated 2 million people die of AKI each year. In this review we focus on classifi cation, diagnostic
methods and clinical management that is available for patients with AKI, with focus on defi nition of AKI according to KDIGO
Guidelines, staging criteria for AKD, strategies for early diagnosis and management and preventing further damage. Focus
on the role of Novel Biomarkers as set up by the consensus groups, such as ADQI, AKI Network, and the American Society
of Nephrology as a priority for early detection of AKI for timely Renal Salvage therapies and improved patient outcome. Th e
review summaries the existing and future tools to guide, investigate and treat AKI in critically ill patients with the objective to
improve patient care

Biography:

Badri Prasad Das has completed MD in Anaesthesia and critical care in 2015 from IMS,Banaras Hindu University(BHU),Varanasi; has pursued postgraduatefellowship
in Critical Care medicine from Trauma centre,BHU(Varanasi), NeuroCritical Care from NIMHANS(Bengaluru) and CCM from JIPMER(Puducherry).
At present he is working as AssistantProfessor in Anaesthesia and Critical Care,IMS-BHU,Varanasi. He is an instructor for AHA(BLS/ACLS/PALS), FCCS;
programme-coordinator for Comprehensive Emergency Life Support (CELS)course; and an invited faculty in various regional/national workshops & conferences.
He has published more than 10 papers in reputed journals, been serving as a reviewer for various International journals(HPMIJ-Medcrave), has many national/
international awards including education-grant awards from ANZICS.

Abstract:

It is not uncommon to have surprises in ICU. Any patient who is shocked in ICU and not responding to standard therapy,
mandates an echo urgently. A signifi cant decrease in the use of the pulmonary artery catheter aft er several negative trials
has led to search for an alternate non-invasive modality. Th ere has been an accumulation of clinical evidence documenting
the additional value of echocardiography compared to traditional invasive hemodynamic assessment. Transthoracic
echocardiography done for critically ill patients is diff erent from that for outdoor patients visiting cardiologists. Th ere are
multifaceted reasons for it. Th e critically ill patents are supine, sedated and oft en ventilated and interpretation has to be done
in presence of positive pressure ventilation, inotropes, variable loading conditions and diff erent CO2 tensions. Hence, the
intensivists working in ICU should be confi dent about every aspect of echo: “When to see, What to see, How to see”. In this ppt
based/hands-on workshop, for around 30 -40 min, emphasis will be given to goal directed, quick and focused studies to assess
left ventricular systolic and diastolic function, diagnosis of right sided failure, pulmonary artery pressure (PAP), to assess if
heart is full or empty, cardiac tamponade in trauma, regional wall motion abnormalities (RWMA).

Biography:

Sourabh Jain is a Senior Resident in Department of Anesthesiology, Critical care and Pain Management at A.I.I.M.S., Bhopal, India. He majored his Graduation
degree from D.A.V.V. university, Indore and M.D. Anesthesia from Madhya Pradesh Medical Science University, Jabalpur, India. He is a young researcher and
his interests include Pain Management, Anesthesia for Morbidly Obese and Diffi cult Airway Management. He is actively involved in experimental research in the
above-mentioned areas. It is his passion to be involved in various Social and Humanitarian activities which includes helping the underprivileged children and also
organizes health camps in collaboration with friends from various fi elds in local area. His leadership skills have also been time tested since school days where he
held various posts successfully. One of the Music and Travel Freak and loves going out on adventures, trekking and photography.

Abstract:

Aims & Objective: Transversus Abdominis Plane Block (TAPB) is a regional anaesthesia technique. It provides analgesia aft er
lower abdominal surgery particularly where parietal wall pain forms major component of pain. It allows sensory blockade of
lower abdominal wall skin and muscles via local anesthetic deposition above transversus abdominis muscle. We evaluated
effi cacy of TAPB with bupivacaine and ropivacaine for postoperative analgesia in lower segment caesarean section, a double
blind, and prospective, randomized controlled clinical trial.
Method: 60 parturient undergoing elective or emergency LSCS were randomized to undergo TAP Block with ropivacaine (n
= 30) or bupivacaine (n = 30). TAP Block were performed at the end of surgery using 20 ml of 0.25 % ropivacaine or 0.25 %
bupivacaine each side. Each patient was assessed postoperatively by a blinded observer at 30 mins , 2 , 4, 6, 12 & 24 hours in ward.
Result: Th e results in both the groups were comparable clinically as well as statistically.
Conclusion: Th us we conclude that there is no signifi cant diff erence between 0.25% Bupivacaine and 0.25% Ropivacaine when
used in TAP Block for providing postoperative analgesia aft er lower segment caesarean section surgery. Both drugs have an
excellent safety profi le. Both drugs show outstanding clinical utility in terms of reliability & effective analgesia

Biography:

Pallavi Ahluwalia has her expertise in airway management, palliative care and pain management. Her research areas focus predominantly on methods to improve
patient”s comfort during the perioperative period. Her publications include studies on various adjuvants to improve the effi cacy of local anaesthetics during regional
anaesthesia She has explored various imaging modalities and ultrasound to improve visualization of airway in anticipated diffi cult airway situations. She is a prolific writer and has contributed many editorials in various indexed journals.

Abstract:

Fluid management is a very complicated and unresolved riddle. Th e debate about fl uid management in the operating
room is still not concluded. Th e traditional approach to perioperative fl uid management has no sound evidence base
and causes perioperative fl uid and salt overload. Enhanced recovery programs emphasize the avoidance of salt and water
overload. Enhanced recovery aft er surgery1 (ERAS) programs have gained accep-tance as a multifactorial, evidence-driven
multidisciplinary way of managing patients undergoing surgery. Th e primary components of ERAS programs are careful
preoperative optimization, improvements in intraoperative management, particularly with regard to fl uid management.
Excess salt and fl uid in the perioperative period is now generally accepted as harmful. Th e various problems associated with
classical approach are listed below (Table-1). Lowell and associates2 studied postoperative criti¬cal care patients and found
that perioperative weight gain (fl uid excess) was highly associated with increase in mortality. Fluid and salt excess can lead
to edema of tissues particularly airways, increased lung water, and cardiac failure. Relative fl uid restriction (as compared
with the traditional approach) is associated with improved outcomes and have been found in prospective studies of general
surgical patients published in the surgery and Anesthesiology literature. Few other benefi ts like shorter hospital lengths of
stay, improved wound healing, fewer surgical infections, and fewer cardiovascular and pulmonary complications have all been
associated with relative fl uid restriction and are supported by a metaanalysis. 5 Zero fl uid balance is recommended, using a
goal-directed approach . Administering goal-directed fl uid therapy involves cardiovascular monitoring such as minimally
invasive cardiac output and the application of an algorithm or guidelines specifi c to fl uid and hemodynamic management.
Goal-directed fl uid therapy6,7 and enhanced recovery programs increase quality by decreasing variability in practice with
evidence-based management. Decreased cost results from lesser perioperative morbidity and streamlined care delivery. Various
monitors may be used for goal-directed fl uid therapy, ranging from invasive (pulmonary artery catheter) to non-invasive
(fi nger cuff cardiac output). Th e choices are based on the clinical situations and the individual or institutional preference. Th e
most common monitors used are oesophageal Doppler and arterial pulse wave analysis systems. Goal-directed fl uid therapy
algorithms may be based on cardiovascular performance (e.g., cardiac output) or preload responsiveness (e.g., stroke volume
variation (SVV). Algorithms t incorporating both is likely to be the most eff ective. GDT is recommended for major procedures
during which substantial blood loss or fl uid shift s are anticipated. Th ese may include major general, vascular, urologic, or
orthopaedic surgeries such as pancreatec-tomy, open colectomy, radical cystectomy .Major patient comorbidities such as
cardiac disease or a debilitated state may prompt the use of GDT as well. GDT has been studied in cardiac surgery with some
positive results. Certainly cardiac anesthesiologists and surgeons apply goals, hemodynamic monitoring, and interventions
in managing their patients perioperatively. Goal-directed fl uid therapy, enhanced recovery programs, and the perioperative
surgical home are ways to control costs while improving quality.

Biography:

Qasem Shehab is a consultant Obstetrician and Gynecologist and subspecialist in Urogynaecology and laparoscopic surgery. He completed his training in the UK,
and worked as consultant between 2014 and 2018, when he relocated to Jordan. Currently he works as Assistant professor at Yarmouk medical school. Beside his
private work he oversees the residency program in Arab Medical Centre. He is trustee of international royal college in Jordan.

Abstract:

Nerve injuries are common complications of gynecological surgery, occurring in up
to 2% of cases. Neuropathies can cause considerable postoperative morbidity, as
well as medico- legal implications. Patient mal-positioning, incorrect placement of selfretaining
retractors, hematoma, formation and direct nerve entrapment or transection
is the primary causative factors in perioperative nerve injury. Nerves most commonly
injured during surgery include the femoral, illioinguinal, pudendal, obturator, and lateral
cutaneous, iliohypogastric and genitofemoral nerves. Th e majority of nerve injuries will
have good prognosis, with minimal or no intervention necessary for the resolution of the
neurological impairment. A minority of patients would sustain long term complications
necessitating prolonged treatment or even reparative surgery. Th e role of multidisciplinary
team including surgeon, anesthetist and physiotherapist is of paramount importance, to
improve outcome and decrease morbidities. Involvement of whole theatre team would
result in better outcome and decreasing risk of preventable nerve injury. Th e injuries, although most have good prognosis,
are largely preventable, through proper care in positioning patients for vaginal or endoscopic gynecological surgery. In this
presentation the speaker will outline the anatomy of susceptible nerves, describe common mechanisms of injury and discuss
management of such injuries.

Biography:

Iram Mir is a post graduate in Anesthesia and Intensive Care from University of Kashmir 2005, India. Worked in Kuwait from 2008-2014. She is a specialist in
intensive care, Rashid hospital and Trauma Hospital, Dubai.

Abstract:

Health care delivery systems which are safe and provide Quality care have been the foundation for imparting and improving
global health. In spite of the recent advances in Technology, medical research and vast turnover of medical and nursing
professionals there has been some pitfalls in delivery of these services and safe management in the Health Care system. In
1999, a report on Quality of health care in America, by Donaldson,” To Err is Human”, highlighted the issue. Th e scale of the
problem was further elucidated by the various studies, research and group and consensus meetings that have taken place since
then. Th e Harvard Study found 4% of patient’s suffer some kind of harm in hospital; 70% of the adverse events result in short
term disability and 14% lead to death. Th e Institute of Medicine (IOM), report estimated that medical errors are a cause of 44
000 - 98 000 deaths annually in hospitals in USA. Th e consequence of such adverse events add to the fi nancial cost, in addition
lead to erosion of trust, confi dence and satisfaction among both the public and the health care provider. Safety is a fundamental
principle of patient care and management. In 2005, WHO’s World Alliance for patient Safety (WAPS), undertook a project
to develop an International Classifi cation for Patient Safety (ICPS) and formed a conceptual framework for the same, with
the purpose to standardize safety in health care. Th e Intensive Care by virtue of use of technology, aggressive level of care of
seriously ill patients requires high standards of safety to deliver Quality care, but is not without short comings in execution of its
goals. Adverse events are bound to occur as a result of human error, poor organization nevertheless representing tremendous
opportunity to study and implement patient safety. In 2006 the Society of Critical Care Medicine task force, created a guide to
development, implementation, evaluation and maintenance of interdisciplinary quality improvement programs in ICU. Th is
was followed by the European Society of Intensive Care, task force and declaration of Vienna in 2009. In 2011, the society
came up with 9 set of indicators used to evaluate quality and improve safety in ICU. Th is Comprehensive review provides an
understanding of defi nition of patient safety according to the WHO guidelines, the severity of the problem in the ICU’s and
how implementing the effective leadership and following international guidelines will help in improving safety and Quality of
care in ICU.

Biography:

Abstract:

Thrombocytopenia complicates 10% of pregnancies as a result of several etiologic factors. Th rombocytopenia may be
preexisting or can develop as a result of the pregnancy. Th rombocytopenia that develops aft er 20 weeks gestation may
be a sign of preeclampsia. However, most thrombocytopenia in pregnancy is benign, gestational thrombocytopenia. Platelet
count is expected to decrease by approximately 10% in normal pregnancy. Autoimmune thrombocytopenia, anti-phospholipid
syndrome, and liver disease are less common. No platelet count is universally accepted as safe for neuraxial anesthesia. Most
anesthesiologists agree that neuraxial anesthesia in the setting of a platelet count greater than 100,000/mm is safe and neuraxial
anesthesia with platelets less than 50,000/mm is unsafe. Disagreement exists about the safety of neuraxial anesthesia at platelet
counts between 50 and 100,000/ mm. Management of anesthesia in obstetric patients should not be based on a single parameter
in pregnant women with severe thrombocytopenia. Besides the platelet count, other laboratory fi ndings should be paired with
TEG and clinical fi ndings and a decision should be rendered aft er considering the patient-specifi c risks and benefi ts regarding
the use of general or regional anesthesia.

Biography:

Husham Al-Shather is a consultant in pain medicine and anaesthesia. He special-ises in the management of chronic pain conditions. He provides a variety of
in-terventional and non-interventional treatments for this specifi c patient popula-tion. Husham is a Fellow of the Faculty of Pain Medicine of the Royal College of
Anaesthetists and a Fellow of the Royal College of Anaesthetists. Since he joined The Royal Berkshire NHS Foundation Trust as a consultant in Pain Management
and Anaesthetics in 2016, he has developed a very good reputation in providing patients with optimal clinical care and scored highly for rating of clinical effectiveness
and patient satisfaction. This has been gained by working in a robust multidisciplinary team which emphasises the use of proven and evidence based medicine.

Abstract:

Biography:

Abstract:

Abnormalities of chorionic villi with trophoblastic proliferation and villous stromal oedema are the characteristics of molar
pregnancy. Moles usually occupy the uterine cavity, but ovary and oviduct can be an ectopic site. Molar pregnancy can
be complete or partial depending on the presence or absence of embryonic elements, respectively. Th e patient may present
with vaginal bleeding, increased uterine size, hyperemesis gravidarum, DIC, pre-eclampsia, hyperthyroidism, or; thyroid
storm, theca lutein ovarian cysts. Trophoblastic embolisation with respiratory distress (RD) can occur rarely in a patient with
complete mole. Cardiopulmonary dysfunction has been observed aft er the removal of benign hydatidiform mole which can
lead to substantial morbidity and mortality. Because of the myriad of presentations of molar pregnancy, the anesthetist has to
be alert and has high index of suspicion to identify and manage these complication early so substantial related morbidity and
mortality can be prevented.

Biography:

A Physician, graduated 1991, Anesthesiologist, worked as a direct patient carer from 1992, in 2002 there was a turn point in my thinking after I had been exposed to
an infl uential experience. I am proud of the best decision I have ever made, the decision to change my career from treating patients to treating healthcare systems.
I started to fi nd the answers to many questions; why our patients are not satisfi ed, why we make errors, why all of us suffer, why a lot of resources are utilized to
produce a minimum outcome. The answer of all those questions is that” Every system is perfectly designed to get the results it gets”. In looking at the total of our
work, I realized that we are focusing on individual work rather than the whole system. Treating diseased people is the main core of healthcare, but treating diseased
healthcare systems is a priority.

Abstract:

In 2002, when I was dealing with a case of sudden cardiac arrest, the case was 19 years old female who had gone through a
tonsillectomy procedure. I breathed a sigh of relief when the case was revived aft er an eff ective CPR, all vital signs became
within the acceptable range in addition to a spontaneous regular breathing. I met the patient family and reassured them. An
hour later, the monitor declared an alarm with fl at ECG, and the case passed away irrespective of the continuous attempts of
CPR. I was so distracted, couldn’t meet the family again and I told my collages to take charge. Aft er that I said what I had been
told 8 years back from my consultant; I have to leave, please cover me. Over the years, I’ve never forgotten that case or the
events of that day. Now, 16 years later, however I changed my career, it still haunts me.
Accountable: It is not easy to answer the fi rst part of the question, unless we understand the concept of medical errors.
As an opportunity for improvement not an area of blame. (Actions to prevent recurrence)
Second Victim: Second Victims are “healthcare providers who are involved in an unanticipated adverse patient event, medical
error and/or a patient related injury and become victimized in the sense that the provider is traumatized by the event. Second
Victim is referring to the impact on the healthcare providers involved in a negative patient outcome- especially when there has
been an error or the provider feels responsibility for the outcome. Th ese events may cause the provider to feel guilty, fearful,
frustrated, anxious, depressed, demoralized and even suicidal. When accounting for numbers of active physicians per specialty,
anesthesiologists are more than twice as likely to die by suicide than any other physician. Surgeons are number two, then
emergency medicine physicians, obstetrician/gynecologists, and psychiatrists. University of Missouri study survey revealed
30% of respondents felt “persistently bad and at least somewhat impaired during the fi rst year aft er an incident. Another survey
of practicing American and Canadian physicians many suff ered from anxiety regarding future errors (61%), loss of confi dence
(44%), sleep disturbances (42%) and lower job satisfaction (42%). Only 10% of these doctors felt the institutions supported
them adequately.