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

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.