[Downloaded free from http://www.saudija.org on Wednesday, September 21, 2016, IP: 117.197.253.
32]
Letters to Editor
Use of WhatsApp for sharing preanesthesia evaluation form
among anesthesiologists
Sir,
Every patient who is scheduled to undergo a surgery or a
procedure under anesthesia has to undergo a preanesthesia
evaluation or a preanesthesia checkup (PAC). The patient and
the patients relatives meet the anesthesiologist for the 1st
time during PAC. As per the practice advisory published by
the American Society of Anesthesiologists (ASA) taskforce,
PAC is defined as the process of clinical assessment that
precedes the delivery of anesthesia care for surgery and for
nonsurgical procedures.[1] The initial PAC involves history
taking, general and relevant systemic examination, any
known drug allergy, airway and spine examination, review
of patients medical records (ongoing medications, doses,
duration), and noting the investigations already done on
surgeons advice. At times, the anesthesiologists ask for
specialist consultation (cardiology, nephrology, pulmonology,
etc.) depending on the severity of systemic disease.
Sometimes additional investigations are requested such
as pulmonary function test, liver function test, and arterial
blood gas on room air.[2,3] The patient is certified fit under
suitable ASA grade by the anesthesiologist after reviewing
all the advised consultations and additional investigations.
The patient is explained the anesthetic technique (general,
regional, minimum alveolar concentration), risks involved,
possible issues such as ventilatory support, intensive care
unit stay, blood transfusion, etc. Everything is documented
in the PAC form, and the patient is asked to visit the surgeon
to finalize the date of surgery.
In several hospitals, the PAC form is scanned for Departmental
use after clearing the patient for anesthesia, or after the
patient has recovered from anesthesia, or while getting
discharged. Usually, all team members are not aware of
a particular case unless it is a high-risk caseinvolving
meticulous perioperative care involving invasive lines.
The anesthesiologist anesthetizing the patient might not
necessarily be the same who cleared the patient during
PAC. In such situations, the anesthesiologist sees the patient
and knows the details after reviewing the PAC form in the
operation theater premises.
480 2016 Saudi Journal of Anesthesia | Published by Wolters Kluwer - Medknow
In our department, we use WhatsApp to circulate all PAC
forms cleared for surgery under anesthesia among all
departmental members. Everyone can go through the PAC
form a day prior to surgery once the list is published by
the operation theater manager and emailed to everyone.[4]
We have made a PAC group on WhatsApp were everyone
including Head of Department, senior consultants, and
registrars are members. Whenever any anesthesiologist clears
a patient after PAC, a snap is taken and posted on the PAC
group. In this way, everyone has a record of all patients who
are certified fit for anesthesia under appropriate ASA grade
and knows about the patients comorbidities, other areas of
difficulty (poor venous access, difficult airway or spine, need
for invasive lines), which is highlighted in the PAC form. The
image gets stored in the gallery of the smartphone and can be
easily accessed whenever the anesthesiologist wants to know
about the patient and the underlying problems important
from anesthesia point of view.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Abhijit S. Nair, Ravi Kiran Mudunuri,
MuthuswamyGanapathy, Venugopal Kulkarni
Department of Anesthesia, Pain and Critical Care Medicine,
Citizens Hospital, Serilingampally, Hyderabad, Telangana, India
Address for correspondence:
Dr. Abhijit S. Nair,
Department of Anesthesia, Pain and Critical Care Medicine,
CitizensHospital, Serilingampally, Hyderabad - 500 019,
Telangana, India.
E-mail: abhijitnair95@gmail.com
References
1. Committee on Standards and Practice Parameters, Apfelbaum JL,
ConnisRT, Nickinovich DG; American Society of Anesthesiologists
Task Force on Preanesthesia Evaluation, Pasternak LR, Arens JF, et al.
Practice advisory for preanesthesia evaluation: An updated report by
the American Society of Anesthesiologists Task Force on Preanesthesia
[Downloaded free from http://www.saudija.org on Wednesday, September 21, 2016, IP: 117.197.253.32]
Letters to Editor
Evaluation. Anesthesiology 2012;116:522-38.
2. Kitts JB. The preoperative assessment: Who is responsible? Can J Anesth
1997;44:1232-6.
3. Zambouri A. Preoperative evaluation and preparation for anesthesia and
surgery. Hippokratia 2007;11:13-21.
4. Thota RS, Divatia JV. WhatsApp: What an app! Indian J Crit Care Med
2015;19:363-5.
This is an open access article distributed under the terms of the
Creative Commons Attribution-NonCommercial-ShareAlike 3.0
License, which allows others to remix, tweak, and build upon the
work non-commercially, as long as the author is credited and the
new creations are licensed under the identical terms.
Tension pneumothorax as a complication of colonic perforation
during colonoscopy: An anesthesiologists nightmare
Sir,
Colonoscopy is a routinely performed diagnostic and
therapeutic procedure in the day care suite. Although rare,
a colonic perforation (CP) is the most serious complication
of colonoscopy. Continued insufflation of air or carbon
dioxide into a perforated colon during endoscopic repair
of these perforations can result in extraluminal leakage
of gas resulting in pneumothorax, pneumomediastinum,
subcutaneous (S/C) emphysema, and pneumoperitoneum. In
this report, we describe the development of a life-threatening
tension pneumothorax and S/C emphysema following
iatrogenic perforation during a diagnostic colonoscopy.
A 66-year-old American Society of Anesthesiologists (ASA)
class I woman with no comorbidities underwent a diagnostic
colonoscopy in day care suite in propofol sedation. Monitoring
of all vital parameters was done throughout the procedure
in accordance with ASA standards. Supplemental oxygen
was provided with a Hudson face mask at 5 L/min. The
endoscopic procedure was aided with insufflation of air.
Within 10 min of the procedure, a rectosigmoid perforation
was recognized by the gastroenterologist. The abdomen
was distended and tympanic in nature with the patient
complaining of abdominal pain. Her vital parameters were
stable with no respiratory distress at that time. Broad spectrum
antibiotics (meropenem and metronidazole) were immediately
administered intravenously; surgical opinion was sought, and
a senior gastroenterologist attempted an endoscopic closure
of the perforation, under air insufflation, but failed. Sedation
was reduced to minimal levels required for the procedure.
Saudi Journal of Anesthesia / October-December 2016 / Volume 10 / Issue 4
Access this article online
Quick Response Code
Website:
www.saudija.org
DOI:
10.4103/1658-354X.177332
How to cite this article: Nair AS, Mudunuri RK, Ganapathy M, Kulkarni V.
Use of WhatsApp for sharing preanesthesia evaluation form among
anesthesiologists. Saudi J Anaesth 2016;10:480-1.
During therapeutic endoscopy, she developed progressive
abdominal distension, respiratory distress, and tachycardia.
Fifteen minutes into the procedure, the patient developed
sudden bradycardia (heart rate 40/min), hypoxia (SpO2 70%),
and decreased level of consciousness. The colonoscope was
immediately withdrawn, and the patient was turned supine.
The patient was cyanosed, and her breathing was labored.
Assisted bag-mask ventilation was initiated with 100% oxygen
utilizing a Mapleson C breathing circuit, but her saturation
remained at 70%. She was noted to have excessive S/C
crepitation (suggestive of S/C emphysema) over the chest and
neck. Her neck veins were extensively distended bilaterally.
The patient was immediately intubated with a 7.5 mm cuffed
endotracheal tube following 150 gm fentanyl and 75 mg of
succinylcholine. Following intubation (confirmed with EtCO2
monitoring), the compliance of the reservoir bag was very
poor, and the patient required very high pressures to ventilate.
On auscultation, breath sounds were absent on the right side,
feeble peripheral pulses with systolic blood pressure of 70
mm of Hg. A large bore IV access was secured. Intravenous
fluids were administered, and vasopressor (noradrenaline)
was initiated. Due to the emergent nature of the situation, a
rapid assessment to confirm the suspicion of pneumothorax
was done using ultrasonography, which revealed the absence
of any evidence of pleural sliding. A 16 gauge IV cannula was
immediately inserted percutaneously in the second intercostal
space in the midclavicular line. The release of a gush of air
immediately from the cannula confirmed pneumothorax. The
cannula was connected to an underwater drainage seal system.
481