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

Biography:

Jihad Mallat, MD, is a Staff Physician in the Respiratory & Critical Care Institute at Cleveland Clinic Abu Dhabi, specializing in anesthesiology, intensive care, and
critical care medicine. Dr. Mallat received his medical degree from the University of Lille II Faculty of Medicine, in Lille, France. He is a member of several medical
associations, including the European Society of Intensive Care Medicine, the Society of Critical Care Medicine, the Intensive Care Society, the French Society of
Intensive Care, and the European Society of Anaesthesiology. He has made a signifi cant contribution to research into critical care medicine, in areas including
circulatory failure and its management, heart-lung interactions, and issues related to ventilation and respiration for critical care patients and has published more
than 50 articles in peer-reviewed journals.

Abstract:

The mixed venous-to-arterial carbon dioxide (CO2) tension difference [P (v-a) CO2] is the difference between carbon dioxide
tension (PCO2) in the mixed venous blood (sampled from a pulmonary artery catheter) and the PCO2 in arterial blood. P (va)
CO2 depends on the cardiac output and the global CO2 production, and on the complex relationship between PCO2 and
CO2 content. Experimental and clinical studies support the evidence that P (v-a) CO2 cannot serve as an indicator of tissue
hypoxia, and should be regarded as an indicator of the adequacy of venous blood to wash out the total CO2 generated by the
peripheral tissues. P (v-a) CO2 can be replaced by the central venous-to-arterial CO2 difference (ΔPCO2), which is calculated
from the simultaneous sampling of central venous blood from a central vein catheter and arterial blood and, therefore, more
easy to obtain at the bedside. Determining the ΔPCO2 during the resuscitation of septic shock patients might be useful when
deciding when to continue resuscitation despite a central venous oxygen saturation (ScvO2) > 70% associated with elevated
blood lactate levels. Because high blood lactate levels is not a discriminatory factor in determining the source of that stress, an
increased ΔPCO2 (> 6 mmHg) could be used to identify patients who still remain inadequately resuscitated. Monitoring the
ΔPCO2 from the beginning of the reanimation of septic shock patients might be a valuable means to evaluate the adequacy of
cardiac output in tissue perfusion and, thus, guiding the therapy. In this respect, it can aid to titrate inotropes to adjust oxygen
delivery to CO2 production, or to choose between hemoglobin correction or fluid/inotrope infusion in patients with a too
low ScvO2 related to metabolic demand. The combination of P (v-a) CO2 or ΔPCO2 with oxygen-derived parameters through
the calculation of the P (v-a) CO2 or ΔPCO2/arteriovenous oxygen content difference ratio can detect the presence of global
anaerobic metabolism.

Biography:

Abstract:

Anxieties, fear of unknown and new environment are signifi cant 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 behavior. The incidence of preoperative distress maybe as high as
60% leading to resisting the anesthesiologist at induction or violent behavior at the time of shift ing and induction of anesthesia.
60% of children who underwent anesthesia manifests negative behavioral changes up-to two weeks postoperatively while
in 20% of cases these may continue for six months. Apart from undesirable eff ects 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
behavioral changes, sleep disturbances and separation anxiety in the post-operative period. Uses of pharmacological or nonpharmacological
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 favorable 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 postgraduatefellowship
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 insuffi cient 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 eff ect. We did a study to explore the impact of tolvaptan when added to HTS on
osmolar effi cacy in such patients. A single-centric, prospective, double-blind, investigator-initiated clinical comparative trial
was conducted in between June 2017-June 2018 at Trauma ICU,IMS-BHU,Varanasi, in which 76 adult patients with severeTBI
belonging to age group 15-70 years, receiving aliquots of 2.5ml/kg of 3%HTS for refractory-ICH, were randomised 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 signifi cantly 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). Th e outcome parameters (duration
of hospital stay 22 ± 10 vs 42 ± 11 days;p=0.04) and unfavorable 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 centre, with use of tolvaptan which not only curtails the eff ect of urinary sodium loss,
thereby increasing osmolar effi cacy of HTS but also leads to better ICP control in severe TBI, translating into better GOS with
mortality benefi t.

Biography:

Helen Gharaei (Date of Birth: March 21, 1967) has completed her MD at the age of 25 years from Mashhad University of medical science and postdoctoral studies
in anesthesiology from the Urmia university school of medicine. She has got her pain fellow degree from Tehran University of medical science and her FIPP degree
(Fellowship of Interventional Pain Practice) from Texas Tech University in USA. She is consultant pain specialist at Milad hospital and consultant interventional pain
specialist in educational committee of fellowship training in the spine and spinal cord injury medicine of Iran .She is well known for her publications on ultrasound-guided
spine and nerve blocks. She is a frequent speaker at international meetings and taught many hands-on workshop. She has published books and many
papers in reputed journals and has been serving as editor in Medicine journal and many others.

Abstract:

New advances in ultrasound create this technology accessible to health care suppliers in daycare clinic. Ultrasound aids pain
interventionist with real-time scanning and identifi cation of the spine. Th ere’s presently mounting proof that ultrasound
improves patient safety enhances health care quality and reduces tending price. Th e evolving aff ordability of ultrasound has
created this technology widely accessible. Ultrasound permits satisfactory scanning of the posterior elements of the spine and
paraspinal soft tissues. Studies illustrated practicability and validity of ultrasound in spinal injections. Despite the introduction
of newer and less consuming time’s methods with the possibility of intravascular injection, there is still insuffi cient clinical
evidence to prove the safety of the ultrasound as a sole image guide intervention, especially for transforaminal injection. Th e
most important injection warnings are damage to the spinal cord and nerve roots, intravascular injection and vascular damage,
loss of consciousness, paraplegia and incontinence. Th e object of study is to discuss the untoward dangerous complication
which can happen aft er ultrasound-guided spine injections and explain how to diagnosis and manage them to supply the
best and safest methodology of ultrasound-guided spine injections. According to the limitations and recommendations for
injection safety, ultrasound training is essential, given its axial ability to spinal anesthesia.

Biography:

Nagi Amer is a consultant anesthesist and icu haad license d3953 and has additional specialization in interventional pain ultrasound guided treatment. He worked
as an HOD of anesthesia, icu and pain in medeor h in ad and al raha h in ad. He has international publications in the related fi eld.

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 is a 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 significant difference 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. Th is study was conducted to compare the eff ectiveness
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 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
the complication, with the development of CKD and ESRD and increase mortality and morbidity leading to high financial health
care costs and burden. Estimated 2 million people die of AKI each year. In this review, we focus on classification, diagnostic
methods and clinical management that is available for patients with AKI, with a focus on the definition 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. The
review summaries the existing and future tools to guide, investigate and treat AKI in critically ill patients with the objective to
improve patient care.