Journal of Clinical Anesthesiology: Open Access

Although the phenomenon of Autonomic Hyperreflexia (AHR) in patients undergoing bladder surgeries is well documented, there is very scarce literature regarding its presentation in other intra- abdominal surgeries. The life expectancy of patients with traumatic paraplegia in the age group of 20-40 yrs is about 25-45 yrs.

The survival of patients with spinal cord injuries (SCI) is increasing, these patients could present to the anaesthesiologist for a wide variety of surgeries. Autonomic dysreflexia (AD) also described as autonomic hyperreflexia (AHR) or mass reflex is characterized by a widespread reflex sympathetic discharge in patients with spinal cord lesions above the level of T6.

It presents as a life threatening medical emergency with elevated blood pressures. Our case presents a unique opportunity to discuss the implications of pneumo-peritoneum which is an essential aspect of most intra-abdominal surgeries.

Laparoscopic surgeries typically need gas insufflation at pressures of 15-20 mmHg at 2-4 litre/min. Insufflation pressures can cause a rise in intra-abdominal pressures leading to high SVR and increased myocardial contractility. CO₂ absorption can cause rise in catecholamines which in turn induces hypertension and tachycardia. AHR although transient in nature could adversely affect these patients with poor myocardial and cardiovascular reserve leading to myocardial infarction, atrial fibrillation, LV failure, seizures and intra-cerebral haemorrhage.

Introduction: Pain management in critical care units has been a concern for long to be addressed. Unalleviated pain is the most common ailments among critical patients that may seriously affect their wellbeing, health outcomes and quality of life. The purpose of this study was to assess the knowledge of nurses regarding pain management in critically ill patients.

Material and methods: Descriptive cross sectional study design was used to carry out the study. A total of 196 nurses were recruited from the public sector hospitals in Lahore and Islamabad. Non-probability convenience sampling technique was used for the selection of the participants with premeditated inclusion criteria. A selfadministered questionnaire was used to collect the required data after the written consent was secured. The data were analyzed for descriptive and inferential statistics using SPSS.

Results: Majority of the nurses (74%) showed the cryptogram of poor knowledge regarding pain management, 23% were found as having average knowledge, and only 1.5% was reported to have good knowledge. In addition a very scare percentage of 0.5% among nurses demonstrated excellent knowledge regarding pain management according to the proposed data collection instruments

Conclusion: The level of knowledge of the nurses working in critical care units was not up to the required standards. Therefore, there is a dire need to motivate and facilitate nurses for continuation of professional education programs to prepare them for the proper training of pain management that in turn will help to vanish the miseries of patients resulting in terms of having pain.

Electrical devices used in the clinical setting can induce artifacts by various different mechanisms. We aimed to present an example of serious artifact happened during induction of general anesthesia in a child. With the advent of newer surgical technologies and more advanced anesthesia and surgical equipment in the operating room, we are expecting the interference could be an issue, if it is not taken into considerations in advance. Healthcare provider should be aware about this incident and its management.