Anesthesia

Critical Care Anesthesia

Keeping patients comfortable, without pain and distress, and continuously monitoring vital signs is what makes this profession so important. 

What is Anesthesia?

Anesthesia is a medical treatment that prevents the feeling or sensation of pain with or without loss of consciousness during medical procedures. Anesthesiology also includes traditional intraoperative care and sub-specialties like chronic pain management and critical care.

Anesthesiologists are specialized doctors who administer anesthetics to patients, depending on the patient and the pain relief required. The various anesthetics administration routes include injection, inhalation, topical lotions, sprays, skin patches, and eye drops. Anesthesia is usually administered to patients who undergo complicated procedures like surgeries. 

What are Anesthetics?

Anesthetics are drugs that reduce or prevent pain. There are mainly three types of anesthetics used.

In a restricted area of the body, local anesthetics are drugs that, upon topical application or local injection, cause a reversible loss of sensory perception, especially pain. 

Regional anesthetics are local anesthetics that block the sensation perception from a larger body area, such as an arm, leg, or abdomen. 

General anesthetics are drugs that cause a reversible loss of consciousness, immobility, muscle relaxation, and sensation, especially pain. 

When local anesthetics or regional anesthetics are administered, the patient remains conscious, but during the administration of general anesthetics, the patient is unconscious and unaware of his/her surroundings. Anesthetics given to patients in critical care units are usually general anesthetics. 

What do you mean by critical care?

Critical care or Intensive care is a specialized type of care administered to patients with life-threatening injuries and illnesses. They need constant monitoring and comprehensive care and are usually admitted to intensive care units (ICU).

Health-care providers use a lot of different equipment like catheters, dialysis machines, feeding tubes, etc. Devices also monitor the patient’s vital signs and display them on monitors. These machines help keep patients alive, but they can also increase the risk of infection. 

Critical care anesthesia

Critical care anesthesia is a specific type of anesthesia where specialized anesthesiologists care for patients who have recently undergone major surgery or suffer from the effects of severe infections or trauma. 

Critical care anesthesiologists possess the medical knowledge and technical expertise to deal with emergencies. They work in intensive care units as essential doctors of care, also known as intensivists. They have the training to deal with cardiac and pulmonary resuscitation, airway management, advanced life support, and airway control; stabilizing the vitals.

They know how to stabilize and prepare patients for emergency surgeries. They coordinate and work closely with other specialists like surgeons to manage treatments for patients and deliver a full range of care. They act as a connecting link between surgeons and physicians to ensure that they work together effectively and for the same purpose. 

Critical care anesthesiologists continue to care and check on patients multiple times throughout the day and even at night. 

Some of the standard protocols critical care anesthesiologists follow are –

-Monitor the electrical activity of the heart

-Monitor the blood oxygen saturation

-Monitor vital signs like blood pressure, respiratory rate, and heart rate.

Usually, patients in the ICU are given intravenous saline so that they stay hydrated. 

During the coronavirus pandemic, the importance of critical care anesthesia has risen up. Anesthesiologists are working tirelessly to provide the necessary care required for an excessive amount of patients.

The management of COVID-19 patients includes specialized anesthetic care for patients with suspected and confirmed COVID-19, intubation outside operation theatres, oxygenation and ventilation support for acute hypoxemic respiratory failure, emergency management and participation in other patients care aspects.

Anesthesiologists have to be very careful as they will be handling most of the patients with respiratory disorders. Some requirements that need to be followed are 

-All suspected patients must be kept in isolation rooms before their procedure. 

-Anesthesiologists must wear Personal Protective Equipment at all times. 

-Operations, when conducted, should be done in a negative pressure or positive pressure isolation rooms. 

Effect on patients

Effect on patients

Critical care can have a significant impact on patients. Before being administered with anesthesia, patients must undergo a diagnostic assessment to determine his/her ability to survive the stress of anesthesia and surgery. 

Some difficult decisions must be made if the patient is critically ill or closer to death. Some patients may have to be resuscitated. Others can live but only with the aid of machines. The outcomes of these decisions must ensure that the patient undergoes minimal suffering. The entire team of healthcare workers and the patient’s family are involved in making these decisions. 

Anesthesiologists around the world work long hours and fatigable work shifts. Critical care anesthetists have more stress while handling multiple patients and continuously monitoring their vital signs. The coronavirus situation has heavily impacted the work-life of these anesthesiologists, causing even more challenges. 

Anesthesiologists are like the heroes behind a mask who ensure the patient’s safety while other specialists carry out their procedures. We have to thank them to keep us comfortable, pain-free, and in good health.

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Coronary Angiography

Coronary Angiography

Coronary angiography is a diagnostic procedure performed to check the blood flow and presence of any obstruction (blockages) in coronary arteries that supply blood to the cardiac muscles.

How Coronary Angiography is done?

This procedure is done through the radial artery that is present in the wrist and the femoral artery (thighs). Anyone location is chosen to do this procedure. The sheath is placed within the artery using a needle. A tube-like structure known as the diagnostic catheter is passed through the artery towards the aorta ( the biggest blood vessel arising from the heart). The end of the catheter is placed at the opening of the arteries and a contrast dye is injected into the coronaries.

At the same time, fluoroscopy is done which permits the visualization of the flow of the dye through the coronaries and can be seen on a screen. Fluoroscopy uses X-rays to visualize the coronaries. Images are then acquired at different angles to get a complete idea of the coronaries. The catheter is removed along with the sheath from the artery. The wound is then dressed and heals with proper post-care.

Is it painful? Does it create a wound?

A small puncture hole on the skin about 2 mm in diameter is created using a needle puncture. It is done under local anesthesia and does not require any stitches. When properly done it is painless and all that is felt is a tiny prick of the needle.

Does it require admission to the hospital?

It can be done as an out-procedure and the patient can go home on the same day itself. Usually, patients can be discharged after 4 hrs when done via the radial artery and 6 hours when done via the femoral artery.

Is it a dangerous or life-threatening procedure?

It is a relatively safe procedure and needs to be done only by an expert. As it is an invasive procedure, complications may arise depending on various factors involved in a patient’s medical history. Some minor complications that may arise include hematoma at the puncture site, vasospasm, minor allergic reaction to the dye. Very rarely, life-threatening complications like myocardial infarction, arrhythmias, anaphylaxis, stroke, renal failure, or death may occur. However, these are extremely rare cases and occur in less than 1% of patients.

Can coronary angioplasty be done immediately after angiography?

Yes. Angioplasty which involves stenting the blockages seen on angiography can be performed immediately after angiography depending on the clinical circumstances.

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Root Canal Treatment

Root Canal Treatment

A root canal, or more specifically, a root canal treatment, is a procedure dentists use to save a badly infected tooth instead of removing it altogether. 

The pulp is the root’s innermost area, which is richly supplied with blood vessels and nerves. Any kind of sensation of the tooth, like sensitivity or pain, arises from this area. 

The root canal by itself is a region of space in the root of the tooth.

What is Root Canal Treatment?

This is also known as endodontic therapy, endodontic treatment, or root canal therapy. It involves the cleaning, disinfection, decontamination, and filling of the infected area of the root canal.

Removal of the tooth’s pulp and subsequent filling can prevent further microbial contamination and the spread of this infection. However, if the tooth is too damaged, dentists will most likely remove the tooth and replace it with dental implants or partial dentures. 

Why do we need this root canal treatment?

When a tooth gets infected, the bacteria attack the enamel first and slowly make their way through the dentin and eventually into the pulp.If the pulp gets infected, it can lead to tooth abscesses. Symptoms include:

  • Terrible toothaches that can radiate to the jaw and bone.
  • Increased sensitivity to extreme temperature changes
  • Pain while biting 
  • Fever may be present 

More severe cases of infection can also cause bone decay and tooth loss. 

The Procedure

Root canals previously would be excruciating procedures. With newer methods and better technology, it’s a procedure that will not cause a lot of pain and keep teeth healthy and clean. 

Local anesthesia is usually administered to patients undergoing this treatment. An opening is made through the tooth’s crown, and specific instruments are guided into the tooth’s innermost pulp area.

The infected pulp is then removed. Once the tooth is completely clean, the dentist will fill it with inert materials like gutta-percha, a cement made up of zinc-oxide eugenol.

Epoxy resin is used as a binder for gutta-percha. Antiseptic materials like paraformaldehyde containing N2 may also be used. 

Complications

Although this procedure aims to eliminate infection and pain in the mouth, a couple of complications could occur.

  • Infection: infection after a root canal is not common, but if present, it can cause damage in and around the area of the root canal. 
  • Accumulation of unwanted materials: Cholesterol crystals can accumulate and cause irritation and lesions.
  • Immune response: this procedure can trigger an overactive immune response that leads to adverse health impacts.
  • Toxic materials: Filling materials such as amalgam contain mercury and other metals, which can be harmful. 

Modern technology and recent findings have made complicated procedures such as root canals easier to carry out with a higher success rate. The pain caused due to a root canal is tolerable than the pain of an infected tooth.

Moreover, having a lax attitude can also spread the infection to other teeth in the mouth. Regular checkups, good mouth hygiene, and eating healthy foods can help prevent any kind of complication to the teeth.

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The Covid-19 Spread in India.

Children Major Cause for Driving The Covid-19 Spread in India.

The Covid-19 Spread in India.

According to the study, children are 56% less likely than adults to get infected by Sars-Cov-2 when they come in contact with an infected person, but how easily they pass on the infection to others remains unclear according to the study. Children Major Cause for Driving The Covid-19 Spread in India.

Where is a government now planning to reopen schools and colleges, the situation can be worsened in the country? In a finding with implications for reopening schools, a new study has established that children and teenagers have half the risk of getting infected by Sars-Cov-2, the virus that causes Covid-19, as compared to adults. 

A study analyzed around 6000 children. Published on May 16th this year, the study said 

“There is preliminary evidence that children and young people have lower susceptibility to Sars-CoV-2, with 56% lower odds of being an infected contact.

There is weak evidence that children and young people play a lesser role in transmitting Sars-CoV-2 at a population level. Our study provides no information on the infectivity of children,”

The role of children

Children and young people’s role in spreading the disease depend on several factors, including their susceptibility to infection, the severity of symptoms, viral load, social contact patterns, people’s role children, and risk behavior.

Clinical series and testing of symptomatic cases alone give biased estimates of susceptibility in children, who often don’t develop symptoms.

Although the president of Public Health Foundation of India, K Srinath Reddy, said 

“The susceptibility of children to Sars-Cov2 is low, according to most of the information. If they are asymptomatic, as most are, transmission risk will be  low,”

Research

Studies on Covid-19 prevalence in children have produced widely varying results, the University College London analysis noted.

Extensive studies from Iceland, the Netherlands, and Spain and Italy showed markedly lower Sars-CoV-2 prevalence among children and young people. Still, studies from Sweden, the UK and some cantons in Switzerland and Germany found no difference in infection prevalence between adults and children.

The Swedish Public Health Agency found 4.7% antibody prevalence in children and teenagers, compared to 6.7% in adults aged 20 to 64, and 2.7% in 65 to 70-year-olds, indicating significant spread in schools.

Rajesh Sagar, professor at the department of 

Psychiatry at All India Institute Of Medical Sciences (AIIMS) Delhi said, “Long-lasting school closures not only leads to a loss of learning but the isolation also harms their mental health and social development, so we have to consider whether the harm outweighs the infection risk for children, who can spread it to their families, school staff and the community,”

Socially and economically deprived children who depend on schools for mid-day meals are the ones who are worst affected by this pandemic. 

“Most young children find it difficult to follow social distancing norms and given a large number of students in one classroom, and crowded transport and playgrounds, schools can easily turn into infection clusters if children infect teachers or take the infection to their family and neighborhood, even if they don’t get the severe disease themselves,” said Sagar, who specializes in child mental health.

“School provides a structured setting in which children can learn and develop social competencies, such as self-confidence, friendship, empathy, participation, respect, gratitude, compassion, and responsibility.

Social and emotional learning is important for young people to become conscious members of a solidarity-based community.”  Said a paper on rethinking the role of schools after Covid-19, published in The Lancet

What can be done?

A hybrid model of education with greater dependence on e-learning is being used in many countries that are reopening schools post lockdown, but it has its challenges.

Although Dr.Sagar added,

“Since all children do not have access to online learning because of uneven access, teaching using radio and television should be considered as that group cannot be ignored.”

Alternative theories. 

Some researchers are stating that Child to child spreading has been a tiny fraction of all identified cases. Even where schools or daycare centers have been open, it has stayed low.

For teenagers and up, the spreading rate increases with age. The virus cannot alter the immunity system in children because it hasn’t reached a certain level of maturity. 

However, the risk is that even if kids are less likely to catch the virus or are either asymptomatic (showing no symptoms) or show milder symptoms. Still, they can always actively transmit the germ to another person. So, never rule out the precautions of masking, social distancing, and hygiene.

We in India have passed out a huge coronavirus wave, but we can’t afford to mishandle the situation. Taking self-care is mandatory. Many people have shared their experience regarding their kids getting affected by covid-19. 

Amongst all these theories and explanations, the proposing inferred from the situation is that The evidence clearly shows that all people, regardless of age, can get infected by SARS-CoV-2. While research shows that kids are more resistant to severe illness from the coronavirus, they are still at risk and can spread the virus even if they are not sick.

Researchers evaluated RNA (the genetic blueprint of the virus) in nasal swabs taken from 145 infected people between March and April, including 46 children younger than five and 51 children aged 5 to 17. Children with severe symptoms requiring oxygen support – who would be most likely to have the highest detectable virus levels – were excluded.

Since the virus affects people with underlying medical conditions more severely, everyone with pre-existing conditions is at risk, and children are no exception to this.

Behavioral experts say that since children come in contact with other children more frequently than adults, the risk of transmission, however low, increases more. Schools and colleges are still closed for this very reason. 

 Whatever may be the truth. It’s not safe to jump conclusions straight away. We must follow the experts and if they think that children are likely to spread the virus faster, we must honor their research and not challenge them until a sustainable solution comes up to this pandemic. Our safety is in our hands!

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Post-Diwali Eye & Skin Care

Post-Diwali Eye & Skin Care – Saideep Hospital

Post-Diwali Eye & Skin Care

Diwali is known as the festival of lights, also a celebration known to cause different kinds of injuries. This year let us be aware of how to take good Post-Diwali Eye & Skin Care – Saideep Hospital

Diwali celebrations mean lots of fun and enjoyment. Unfortunately, improper handling and playing with fireworks account for thousands of emergency room visits each year during the festival. Most people do not think of the accidents that could occur during the festivities due to the fireworks and sparklers. The leading cause of injuries on Diwali is the lack of appropriate safety measures during playing with crackers.

Despite the various health and environmental concerns, few still go ahead in bursting crackers. We need to be aware of the eye and skin safety measures to ensure Diwali’s joy stays with us post the celebrations.

The majority of injuries are associated with flowerpot and bottle rocket crackers. Burns are the most common type of injury.

Eyes are the second-most common area to be affected after hands and fingers. Contusions (blood clots), lacerations(cuts), and foreign bodies in the eye are seen frequently. Bottle rockets can fly into people’s faces and cause eye injuries; crackers can damage the eyesight if they explode at a close range.

These eye injuries could cause loss of vision, especially in children. Cracker causes blunt and penetrating injuries to about 6% to 10%, with nitrous oxide and sulfur dioxide levels rise considerably, which also causes irritability and watering of eyes.

Eye Care 

  • Ensure that your eyes are well lubricated (consult your ophthalmologist for medicated drops)
  • Make sure to wash your eyes regularly post Diwali to remove any or all foreign substances.
  • If you are a contact lens wearer, ensure you clean your lenses well post the celebrations. It is advisable to throw the pair that you have worn to avoid any infections or irritations.
  • Don’t press or rub the eye with your palm or hand. In case of an injury, it may get compounded.
  •  If you feel any kind of burning or painful sensation in your eyes, don’t cover it with your hand or cloth as it creates undue pressure on your eye.
  •  It is better to avoid washing eyes in case of mechanical injuries.  In case of a chemical injury, wash the eye well with clean water.
  •  Don’t neglect any eye injury, however trivial it may look. It is always better to rule out vision-threatening problems
  •  If a particle is large or stuck in the eye, do not attempt to remove it. Visit your ophthalmologist immediately
  •  If any chemical substance has entered the eye, immediately wash your eyes with water for a couple of minutes

Skin Care 

  • Consume 8-10 glasses of water every day to keep your skin hydrated. This will also help to keep your scalp cool, hydrated, and breathing all the time. It will help in reducing the effects of crackers and pollution on your skin & hair
  • Include more fruits and nuts in your diet to help your body stabilize after the heavy consumptions of Diwali sweets & snacks
  • Ensure you follow an exfoliating regime post-Diwali, to help your skin breathe from the heavy makeup and pollution it was exposed to.
  • Limit the consumption of sugar after the festive season
  • Consult your doctor in case of burns on the skin
  • If needed, get some medicated facial after Diwali
  • Avoid harsh surface chemical treatments during the Diwali month—be it for skin or hair

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