Online ISSN: 2515-8260

Keywords : pneumothorax

A case of a morbidly obese geriatric patient with permanent pacemaker in situ posted for inter-scapular non healing ulcer debridement-A team work

Dr Jayalakshmi Mohan Dr Yashwanth Nankar Dr Harsha Elizabeth Meleth Dr. Sriram Mahalingam

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 1, Pages 1496-1501

Anaesthesia for geriatric patients who are morbidly obese is quite challenging. Understanding anaesthetic care for such patients can be related to the description of fundamental alterations in physiology and changes in the pharmacokinetics and pharmacodynamics of anaesthetic medications. With advances in cardiology and cardiothoracic surgery, several newer implantable cardiac devices have become common in the surgical population. Cardiac pacemakers are generally required in patients with symptomatic bradycardia or severe conduction block. Many of the newer implantable cardiac electronic devices are targeted at managing heart failure. While managing such patients for non-cardiac surgeries, specific issues related to equipment characteristics and troubleshooting should be a priority for anaesthesiologists. There is a possibility of malfunction of the devices resulting in catastrophic outcomes. Intraoperative care of the pacemaker and understanding its anaesthetic implication is crucial in managing these high-risk patients. We present the anaesthetic management of a case of an elderly morbidly obese male patient, posted for inter-scapular non-healing ulcer debridement having a permanent pacemaker in situ in DDDR (dual-chamber rate-modulated) mode. The pacemaker was changed and inserted previously for complete atrioventricular (AV) block on electrocardiogram (ECG) and degenerative AV conduction disease with complete symptomatic AV (atrioventricular) block, on electrophysiology study. The pacemaker mode changed to asynchronous ventricular pacing mode preoperatively. Erector spinae block with field block was given. The patient tolerated the surgical procedure well, and vital parameters were maintained throughout the operation. After the operation, the patient was shifted to the intensive care unit (ICU), the pacemaker was reprogrammed to DDDR mode, and vigilant monitoring was done. Postoperatively patient developed iatrogenic pneumothorax which was managed successfully by the pulmonology team. The patient was then transferred to the ward on postoperative day 3 in stable condition. This case highlights that a good erector spinae plane block + field block along with vigilant monitoring and team effort is a reasonable choice for elderly obese patients with permanent pacemakers coming for elective surgeries


Dr. Archana S R, Dr. Suresh A, Dr. Muthusubramanian R, Dr. Kishor Sagar V, Dr. Darshitha B, Dr. Bhargavi D

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 150-158

Background: Chest radiograph has been the standard initial imaging modality of choice to
detect pneumothorax. Despite of moderate sensitivity in detection of pneumothorax, due to its
wide range of geographical availability and less expenditure in our country, it has been
widely advocated by all the physicians. Computed Tomography (CT) and Ultrasonography
(USG) being the current point of care in most parts of the country and having no radiation
risks, it can be utilized in early and safe detection of pneumothorax. In this study, we
analyzed the diagnostic utility and efficacy of chest ultrasound in detecting pneumothorax on
comparison to chest x ray.
Methods: Ethical committee clearance and informed consent was taken from all the patients.
Total of 79 patients who were having clinical suspicion of pneumothorax were evaluated.
Initial imaging evaluation was done using B-mode and M-mode chest ultrasonography and
further subjected to chest radiography. Images were assessed by 2 experienced radiologists.
Demographic, clinical and radiological data were documented and analyzed. In the cases of
discrepancy in findings of USG vs. Radiograph, CT was considered the gold standard for
obtaining the final diagnosis.
Results: We found that chest ultrasound had sensitivity of 98.43%, specificity of 100%, PPV
of 100%, NPV of 93.75% and diagnostic accuracy of 98.73%. Chest radiograph had
sensitivity of 73.43%, specificity of 83.33%, PPV of 94%, NPV of 46.9% and diagnostic
accuracy of 78.9%
Conclusion: Chest USG is a useful and essential tool in detection of pneumothorax.
Although chest radiograph being widely available and CT with its highest sensitivity &
specificity, USG stand apart in providing good diagnostic value with no radiation risks.

Characteristics in Thoracic Trauma Patients with Primary Chest Tube Affecting Length of Stay and Mortality Rate

Vasan , Puruhito , Dhihintia Jiwangga S.W

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 1299-1309

Background:Thoracic trauma is the third leading cause of death after abdominal trauma and
head trauma. However, many studies show significant differences that affect morbidity and
mortality. Severe injuries to the thorax can increase the mortality rate by 25% to 30%. This
research was done in order to find predictor characteristics affecting the length of stay and
mortality in thoracic trauma patients.[1,2]
Method: A Retrospective analysis was performed on thoracic trauma patients who had primary
chest tube insertion initial therapy. Data were collected from June 2017 to October 2021 from
medical records in Dr. Soetomo teaching hospital Surabaya. Chi-square was used to compare
the variables, and Multivariabel Logistic Regression was used to identify independent predictor
for length of stay and mortality. The independet predictors were demographics, complication,
and surgical therapy during admission. P-value < 0.05 was considered statistically significant.

Evaluation of Pneumothorax in Neonates in Al Immamian Alkadhomain Medical City

Abbas Jaafar Khaleel Al-Anbari; Dr. Jawad Kkadhum Abid

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 2, Pages 214-219

Introduction: Pneumothorax occur most during neonatal age than other age of life in
human being, this more related to high morbidity and death rate. It started form damage
to alveoli that more distended. The air seepages lengthways of the perivascular sheath of
connective tissue inside to the pleural space, The aim of our study is to assessment of
prevalence, recognize the danger factors and to define the clinical features, treatment and
consequence of neonates that have pneumothorax and determine the fate of neonates
after treatments.
Method: Prospectively collected data from newborn infants with pneumothorax observed
and treated at the Neonatal Intensive Care Unit (NICU) in al immamian alkadhomain
medical city, Sociodemographic data of neonates, clinical features of pneumothorax and
treatment of pneumothorax. Finally, assessment the fate of neonate assessed.
Results: A cross section descriptive study on 41 neonates mean age (34.6 ± 3) weeks
most age group 31 – 40 weeks 85% and weight (2 ± 0.7) kg most neonates (49%) with
2.1 – 3 kg, 34% females and 66% males, 61% of neonates are single parity, 71% of
neonates not need to antenatal steroid, while 56% of neonates delivered by CS, 71% of
neonates with Apgar score less than 7 in first 1 min., Significant association between
sociodemographic variables and clinical features as show in table 4; 52% of right
pneumothorax occur in male, 88% of left pneumothorax occur in male and 100% of
bilateral pneumothorax occur in male. 57% of RDS occur females while 43% of RDS in
male. 100% of TTN occur in single parity. 67% of pneumonia occur at age group 21- 30
week. Significant association between sociodemographic variables and treatment and fate
as show in table 5; 56% of neonate’s need C-pap were females and 44% were males.
56% of neonates need O2 therapy with weight 2.1-3kg, 26% of them that need O2 therapy
with weight 1-2 kg. 55% of alive neonates are males and 45% are females, 72% of single
parity neonates still alive.
Conclusion: Pneumothorax is moderately common in the NICU. The fate of neonates are
71% still alive and 29% dead. Pneumothorax itself was not a factor of death, probably due
to the sufficient and rapid therapy used in the NICU.