Gastrostomy is needed to provide nutritional support in patients with head and neck cancer surger... more Gastrostomy is needed to provide nutritional support in patients with head and neck cancer surgery. The incision in upper abdomen causes moderate pain. We usually encountered our postoperative patients complaining of significant discomfort that leads us to think about adding some regional anesthesia techniques with conventional pain management. Recently, the role of regional anesthetic techniques for involving anterior abdominal wall has been increased. Ten patients who underwent head and neck cancer surgery requiring open surgical gastrostomy for long-term nutritional support were taken into this descriptive case series. In addition to general anesthetic, intravenous nalbuphine, and paracetamol, ultrasound-guided subcostal transversus abdominal plane (TAP) block was performed 30 min prior to incision of gastrostomy to improve postoperative analgesia. All 10 patients had significant pain relief at gastrostomy incision site which is different from our experience in the same patient population before. The numerical rating score (NRS) was between 0 and 2, and average satisfaction score was 7–8 on a scale of 10. The patients reported a very low level of discomfort. No adverse events were recorded up to patient discharge from the hospital. Subcostal TAP block under ultrasound guidance is a valuable addition to improve postoperative pain management in open surgical gastrostomy. The available case series show encouraging analgesic results with no adverse events recorded. Formal prospective randomized trials are needed to provide further evidence on its efficacy, failure rate, and safety.
We present a case that describes the airway management of a patient with recurrent head and neck ... more We present a case that describes the airway management of a patient with recurrent head and neck cancer and confirmed COVID-19 infection. Securing airway of these patients with anticipated difficulty and at the same time limiting virus exposure to providers can be challenging. The risk of aerosolization during awake tracheal intubation is extreme as it carries a high risk of transmitting respiratory infections. A multidisciplinary team discussion before the procedure highlighted aspects of both airway management and the urgency of surgical procedure where particular care and modifications are required. Successful flexible bronchoscopy and intubation was done under inhalational anaesthetics with spontaneous breathing. Although fiberoptic intubation during sleep,in anticipated difficult airways, have led to enhanced intubation time, this technique was opted to minimize the risk of aerosol generation associated with topicalisation, coughing and hence reduced incidence of cross infectio...
Background Tracheal intubation in critically ill patients remains high-risk despite advances in e... more Background Tracheal intubation in critically ill patients remains high-risk despite advances in equipment, technique, and clinical guidelines. Many patients with COVID-19 were in respiratory distress and required intubation that is considered an aerosol-generating procedure (AGP). The transition to videolaryngoscopy as a routine first line option throughout anesthetic and ICU practice has been reported. We evaluated the ease of intubation, success rate, use of accessory maneuvers and adverse outcomes during and 24 hours after intubation with the McGrath videolaryngoscope. Methods This was a prospective, observational single center study conducted at non-operating room locations that included all adults (>18 years old) with suspected or confirmed COVID-19 infection and were intubated by McGrath videolaryngoscope. The anesthesiologist performed tracheal intubation were requested to fill online data collection form. A co-investigator was responsible to coordinate daily with assigned...
The ongoing coronavirus (COVID-19) infection causes severe respiratory dysfunction and has become... more The ongoing coronavirus (COVID-19) infection causes severe respiratory dysfunction and has become an emergent issue for worldwide healthcare due to highly transmissible and contagious nature. Aerosol generating procedures such as tracheal intubation is of particularly high risk. This mandates some advice on processes and techniques required to protect staff and uniform approach during airway management. We hereby share our experience in development of an emergency response system to deal with COVID airway management at a frontline hospital which particularly consider the local demands and resources. This includes a change in working dynamics with 24/7 consultant coverage for emergent or urgent tracheal intubation of COVID patients at non-operating room locations. Other steps include prepackaging intubation baskets, availability of videolaryngoscope, standard personal protective equipment including powered air purifying respirator, and use of modified intubation checklist. doi: https...
Background Tracheal intubation for patients with COVID-19 is required for invasive mechanical ven... more Background Tracheal intubation for patients with COVID-19 is required for invasive mechanical ventilation. The authors sought to describe practice for emergency intubation, estimate success rates and complications, and determine variation in practice and outcomes between high-income and low- and middle-income countries. The authors hypothesized that successful emergency airway management in patients with COVID-19 is associated with geographical and procedural factors. Methods The authors performed a prospective observational cohort study between March 23, 2020, and October 24, 2020, which included 4,476 episodes of emergency tracheal intubation performed by 1,722 clinicians from 607 institutions across 32 countries in patients with suspected or confirmed COVID-19 requiring mechanical ventilation. The authors investigated associations between intubation and operator characteristics, and the primary outcome of first-attempt success. Results Successful first-attempt tracheal intubation...
Annals of the Royal College of Surgeons of England, 2021
INTRODUCTION Tracheomalacia after thyroidectomy is not well understood. Reports on tracheomalacia... more INTRODUCTION Tracheomalacia after thyroidectomy is not well understood. Reports on tracheomalacia are conflicting, with some suggesting a high rate and other large cohorts in which no tracheomalacia is reported. The aim of our study was to assess the incidence and factors associated with tracheomalacia after thyroidectomy in patients with retrosternal goitres requiring sternotomy at a high-volume tertiary care referral centre. METHODS A longitudinal cohort study was conducted from January 2011 to December 2019. All adult patients who underwent thyroidectomy with sternotomy were included. Tracheomalacia was considered when tracheal rings were soft compared with other parts (proximal or distal) of the trachea and required either tracheostomy or resection with anastomosis. The decision to perform a tracheostomy or to administer continuous or bilevel positive airway pressure postoperatively was made depending on the degree of tracheomalacia. Logistic regression analysis was used to asse...
Pregnancy is associated with a wide variety of oral and dental changes ranging from gingivitis to... more Pregnancy is associated with a wide variety of oral and dental changes ranging from gingivitis to odontogenic infections. If left untreated, severe dental abscess can progress to Ludwig’s angina, which is a potentially lethal cellulitis that rapidly extends to the neck region and may lead to life-threatening upper airway obstruction. We report the case of a pregnant woman who presented with intense throbbing pain, trismus and severely reduced mouth opening due to dental abscess for the last one week. She required incision and drainage of abscess with extraction of third molar under general anaesthesia. There are some significant challenges to anaesthesiologist like the risk of aspiration and failed intubation in patients with pregnancy and anticipated difficult airway. With counselling and proper preparation, we were able to manage this case with awake intubation. Continuous...
Objective: To assess the frequency of new-onset cardiac arrhythmias among patients admitted in su... more Objective: To assess the frequency of new-onset cardiac arrhythmias among patients admitted in surgical intensive care unit as well as associated risk factors. Study Design: Retrospective observational study. Place and Duration of Study: Surgical Intensive Care Unit, Aga Khan University Hospital, Karachi, from Jan 2018 to Dec 2019. Methodology: The medical record numbers of all patients admitted in surgical intensive care unit were obtained from Surgical intensive care unit case log entries and reviewed. Patients` and healthcare providers` identification were kept confidential. Data was analyzed using SPSS version 19. Results: Only 13/1076 patients included in the study had cardiac arrhythmias during their stay in Surgical intensive care unit. Among all patients with arrhythmias (n=13), atrial fibrillation was the most common type of arrhythmia 7 (53.8%). The study found higher occurrence of arrhythmias among the patients in the age category of 66 years or above 8 (4.6%) and when co...
The droplets of novel coronavirus disease 2019 (COVID-19) can be transmitted during aerosol-gener... more The droplets of novel coronavirus disease 2019 (COVID-19) can be transmitted during aerosol-generating procedures involving tracheal intubation.1 Anesthesiologists are exposed to a higher risk than other specialty healthcare workers because they manage the airway and ventilation.2 Extubation is as high a risk for aerosolization of respiratory secretions as is intubation. Additional barriers have been described for intubation like using intubation box or clear plastic drapes but limited options have been explored for extubation.3 Some experts suggest placing wet gauze over the patient’s mouth and nose just prior to extubation if the patient starts to cough, and/or covering the patient's face with a clear plastic drape.4
Gastrostomy is needed to provide nutritional support in patients with head and neck cancer surger... more Gastrostomy is needed to provide nutritional support in patients with head and neck cancer surgery. The incision in upper abdomen causes moderate pain. We usually encountered our postoperative patients complaining of significant discomfort that leads us to think about adding some regional anesthesia techniques with conventional pain management. Recently, the role of regional anesthetic techniques for involving anterior abdominal wall has been increased. Ten patients who underwent head and neck cancer surgery requiring open surgical gastrostomy for long-term nutritional support were taken into this descriptive case series. In addition to general anesthetic, intravenous nalbuphine, and paracetamol, ultrasound-guided subcostal transversus abdominal plane (TAP) block was performed 30 min prior to incision of gastrostomy to improve postoperative analgesia. All 10 patients had significant pain relief at gastrostomy incision site which is different from our experience in the same patient population before. The numerical rating score (NRS) was between 0 and 2, and average satisfaction score was 7–8 on a scale of 10. The patients reported a very low level of discomfort. No adverse events were recorded up to patient discharge from the hospital. Subcostal TAP block under ultrasound guidance is a valuable addition to improve postoperative pain management in open surgical gastrostomy. The available case series show encouraging analgesic results with no adverse events recorded. Formal prospective randomized trials are needed to provide further evidence on its efficacy, failure rate, and safety.
We present a case that describes the airway management of a patient with recurrent head and neck ... more We present a case that describes the airway management of a patient with recurrent head and neck cancer and confirmed COVID-19 infection. Securing airway of these patients with anticipated difficulty and at the same time limiting virus exposure to providers can be challenging. The risk of aerosolization during awake tracheal intubation is extreme as it carries a high risk of transmitting respiratory infections. A multidisciplinary team discussion before the procedure highlighted aspects of both airway management and the urgency of surgical procedure where particular care and modifications are required. Successful flexible bronchoscopy and intubation was done under inhalational anaesthetics with spontaneous breathing. Although fiberoptic intubation during sleep,in anticipated difficult airways, have led to enhanced intubation time, this technique was opted to minimize the risk of aerosol generation associated with topicalisation, coughing and hence reduced incidence of cross infectio...
Background Tracheal intubation in critically ill patients remains high-risk despite advances in e... more Background Tracheal intubation in critically ill patients remains high-risk despite advances in equipment, technique, and clinical guidelines. Many patients with COVID-19 were in respiratory distress and required intubation that is considered an aerosol-generating procedure (AGP). The transition to videolaryngoscopy as a routine first line option throughout anesthetic and ICU practice has been reported. We evaluated the ease of intubation, success rate, use of accessory maneuvers and adverse outcomes during and 24 hours after intubation with the McGrath videolaryngoscope. Methods This was a prospective, observational single center study conducted at non-operating room locations that included all adults (>18 years old) with suspected or confirmed COVID-19 infection and were intubated by McGrath videolaryngoscope. The anesthesiologist performed tracheal intubation were requested to fill online data collection form. A co-investigator was responsible to coordinate daily with assigned...
The ongoing coronavirus (COVID-19) infection causes severe respiratory dysfunction and has become... more The ongoing coronavirus (COVID-19) infection causes severe respiratory dysfunction and has become an emergent issue for worldwide healthcare due to highly transmissible and contagious nature. Aerosol generating procedures such as tracheal intubation is of particularly high risk. This mandates some advice on processes and techniques required to protect staff and uniform approach during airway management. We hereby share our experience in development of an emergency response system to deal with COVID airway management at a frontline hospital which particularly consider the local demands and resources. This includes a change in working dynamics with 24/7 consultant coverage for emergent or urgent tracheal intubation of COVID patients at non-operating room locations. Other steps include prepackaging intubation baskets, availability of videolaryngoscope, standard personal protective equipment including powered air purifying respirator, and use of modified intubation checklist. doi: https...
Background Tracheal intubation for patients with COVID-19 is required for invasive mechanical ven... more Background Tracheal intubation for patients with COVID-19 is required for invasive mechanical ventilation. The authors sought to describe practice for emergency intubation, estimate success rates and complications, and determine variation in practice and outcomes between high-income and low- and middle-income countries. The authors hypothesized that successful emergency airway management in patients with COVID-19 is associated with geographical and procedural factors. Methods The authors performed a prospective observational cohort study between March 23, 2020, and October 24, 2020, which included 4,476 episodes of emergency tracheal intubation performed by 1,722 clinicians from 607 institutions across 32 countries in patients with suspected or confirmed COVID-19 requiring mechanical ventilation. The authors investigated associations between intubation and operator characteristics, and the primary outcome of first-attempt success. Results Successful first-attempt tracheal intubation...
Annals of the Royal College of Surgeons of England, 2021
INTRODUCTION Tracheomalacia after thyroidectomy is not well understood. Reports on tracheomalacia... more INTRODUCTION Tracheomalacia after thyroidectomy is not well understood. Reports on tracheomalacia are conflicting, with some suggesting a high rate and other large cohorts in which no tracheomalacia is reported. The aim of our study was to assess the incidence and factors associated with tracheomalacia after thyroidectomy in patients with retrosternal goitres requiring sternotomy at a high-volume tertiary care referral centre. METHODS A longitudinal cohort study was conducted from January 2011 to December 2019. All adult patients who underwent thyroidectomy with sternotomy were included. Tracheomalacia was considered when tracheal rings were soft compared with other parts (proximal or distal) of the trachea and required either tracheostomy or resection with anastomosis. The decision to perform a tracheostomy or to administer continuous or bilevel positive airway pressure postoperatively was made depending on the degree of tracheomalacia. Logistic regression analysis was used to asse...
Pregnancy is associated with a wide variety of oral and dental changes ranging from gingivitis to... more Pregnancy is associated with a wide variety of oral and dental changes ranging from gingivitis to odontogenic infections. If left untreated, severe dental abscess can progress to Ludwig’s angina, which is a potentially lethal cellulitis that rapidly extends to the neck region and may lead to life-threatening upper airway obstruction. We report the case of a pregnant woman who presented with intense throbbing pain, trismus and severely reduced mouth opening due to dental abscess for the last one week. She required incision and drainage of abscess with extraction of third molar under general anaesthesia. There are some significant challenges to anaesthesiologist like the risk of aspiration and failed intubation in patients with pregnancy and anticipated difficult airway. With counselling and proper preparation, we were able to manage this case with awake intubation. Continuous...
Objective: To assess the frequency of new-onset cardiac arrhythmias among patients admitted in su... more Objective: To assess the frequency of new-onset cardiac arrhythmias among patients admitted in surgical intensive care unit as well as associated risk factors. Study Design: Retrospective observational study. Place and Duration of Study: Surgical Intensive Care Unit, Aga Khan University Hospital, Karachi, from Jan 2018 to Dec 2019. Methodology: The medical record numbers of all patients admitted in surgical intensive care unit were obtained from Surgical intensive care unit case log entries and reviewed. Patients` and healthcare providers` identification were kept confidential. Data was analyzed using SPSS version 19. Results: Only 13/1076 patients included in the study had cardiac arrhythmias during their stay in Surgical intensive care unit. Among all patients with arrhythmias (n=13), atrial fibrillation was the most common type of arrhythmia 7 (53.8%). The study found higher occurrence of arrhythmias among the patients in the age category of 66 years or above 8 (4.6%) and when co...
The droplets of novel coronavirus disease 2019 (COVID-19) can be transmitted during aerosol-gener... more The droplets of novel coronavirus disease 2019 (COVID-19) can be transmitted during aerosol-generating procedures involving tracheal intubation.1 Anesthesiologists are exposed to a higher risk than other specialty healthcare workers because they manage the airway and ventilation.2 Extubation is as high a risk for aerosolization of respiratory secretions as is intubation. Additional barriers have been described for intubation like using intubation box or clear plastic drapes but limited options have been explored for extubation.3 Some experts suggest placing wet gauze over the patient’s mouth and nose just prior to extubation if the patient starts to cough, and/or covering the patient's face with a clear plastic drape.4
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Papers by Faisal Shamim