FIELD OF THE INVENTION
[001] The present invention generally relates to anesthesiology.
[002] More particularly, the present invention relates to anaesthetic management
method in guillain-barré syndrome undergoing total hip replacement.
BACKGROUND FOR THE INVENTION:
[003] By reference to RU application no. RU2392976C1 by Federal State
Institution "Nizhny Novgorod Research Institute of Traumatology and Orthopedics
of the Federal Agency for High-Tech Medical Care" dated 2009-03-16, titled”
Method of anesthetic management of orthopedic surgeries in children” discloses
medicine, namely, to anaesthesiology and can be used as anesthesia care of
orthopedic surgeries in children. That is ensured by an initial inhalation narcosis of
Sevoflurane. It is followed with epidural cavity catheterisation and spinal anesthesia
by introduction of Marcaine 0.5% isobaric. In 80 minutes after the beginning of
spinal anesthesia, bolus dosing of 0.2% Naropin 0.6 mg/kg in the epidural space
follows. Continuous infusion of Naropin in the epidural space is maintained at 0.2-
0.3 mg/kg/h during the surgical procedure.
[004] By reference to RU application no. RU2457002C1 by Federal State
Institution "Novosibirsk Research Institute of Traumatology and Orthopedics" of
the Ministry of Health and Social Development of the Russian Federation (FGU
"NNIITO" of the Ministry of Health and Social Development of Russia) dated
2011-02-01, titled” Method of anaesthetic management of intraoperative monitoring
of spinal function” discloses medicine, namely to anaesthesiology, and may be used
as an anaesthesia care of surgical correction of severe spinal scoliosis with a high
risk of developing neurological complications. For this purpose, 30 minutes prior to
the operation, intramuscular pre-medication with Dormicum 0.1 mg/kg and
Dimedrol 0.4 mg/kg is required. The anaesthesia is induced by Phentanyl 0.002
mg/kg, Propofol 2.5 mg/kg. The introduction of Nimbex 0.1 mg/kg is followed by
the trachea intubation. After the trachea intubation and transition to artificial
pulmonary ventilation, loading doses of Clopheline 0.004 mcg/kg and Ketamine
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0.25 mg/kg are introduced. Sevorane in the concentration of 4 vol. % immediately
follows the trachea intubation and transition to artificial pulmonary ventilation
assisted by the air and oxygen flow rate of 4-5 l/min to reach the breath-out
sevorane concentration min. 2.6 vol. % (1.04 minimum alveolar concentration).
Then the air and oxygen flow rate is decreased to 1 l/min. Artificial pulmonary
ventilation is enabled by an anaesthesia apparatus for sevorane delivery in forced
pulmonary ventilation mode with the low fresh gas flow rate 1 l/min with minute
tidal volume to ensure the breath-out concentration of carbon dioxide within 32-37
mm Hg, the concentration of oxygen in the mixture 40%.
[005] By reference to RU application no. RU2012115809A by State Budgetary
Educational Institution of Additional Professional Education Penza Institute for
Advanced Training of Doctors of the Ministry of Health and Social Development of
Russia dated 2012-04-19, titled” METHOD FOR PREVENTING PREVENTIVE
ANESTHESIA IN PATIENTS WITH COMPLICATED MYOCARDIAL
INFARCTION” discloses a method for preventing anesthesia in patients with
complicated myocardial infarction by conducting spinal-epidural analgesia,
characterized in that for the initial relief of anginal status, a single injection of
narcotic analgesics into the subarachnoid space is used and to maintain the
subsequent analgesic effect, preventive injection of narcotic analgesics into the
epidural space is performed maintenance of analgesia using epidural narcotic kih
analgesics in the lumbar once or twice a day with a course of three to seven days.
[006] By reference to RU application no. RU2010152070A by STATE
EDUCATIONAL INSTITUTION OF HIGHER PROFESSIONAL EDUCATION
AMUR STATE MEDICAL ACADEMY Ros, State Educational Institution of
Higher Professional Education Amur State Medical Academy of Roszdrav dated
2010-12-20, titled”METHOD OF APPLICATION OF SUBDURAL ANESTHESIA
AS A METHOD OF ANESTHETIC SUPPORT OF SURFACING OPERATION
ON THE Cervix” discloses method of performing a cervical suture operation under
conditions of subdural anesthesia with hyperbaric bupivacaine, characterized in that
the puncture site is anesthetized with a bupivacaine solution of 0.5% 2-3 ml, the
subdural space is punctured with atraumatic small spinal needles (25-27G Pencil
Point) at the level L3-4, L4-5 medial access, as a local anesthetic, use a hyperbaric
solution of bupivacaine 0.5% in doses of 0.6-1.2 ml, while the patient's sitting
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position is maintained for up to 10 minutes, which allows limiting the sweeping
spread of local anesthetic to reduce the risk of hypotension and to limit the area of
anesthesia exclusively pelvis.
[007] By reference to RU application no. RU2489174C1 by State Budgetary
Educational Institution of Higher Professional Education "Yaroslavl State Medical
Academy" of the Ministry of Health and Social Development of the Russian
Federation dated 2012-03-22, titled” Method of anaesthetic management of surgical
interventions in patients with terminal tracheostoma” discloses medicine, namely to
anaesthesiology, resuscitation and otorhinolaryngology, and can be used if it is
necessary to provide the anaesthetic management in the patients with terminal
tracheostomy. For this purpose, pre-oxygenation, assisted and forced lung
ventilation are conducted before tracheal intubation through a laryngeal mask with
an inflated cuff tightly adjoining a tracheostomy opening. Then, an intubation tube
is inserted into the tracheostomy, and volumetric induced ventilation is conducted
through the above tube.
[008] By reference to RU application no. RU2330688C1 by State Educational
Institution of Higher Professional Education "BASHKIR STATE MEDICAL
UNIVERSITY of the Federal Agency for Health and Social Development dated
2006-12-26 , titled” Method of anaesthetic management within spinal surgical
correction for children suffering from severe scoliosis” discloses general anaesthesia
begins with phased inhalation of Sevoflurane in amount 1 vl% with 0.5 vl% added
per every 3-4 breaths or with bolus inhalation Sevoflurane in amount 8 vl%
consequently reduced to 2.5 vl% till patient becomes unconscious. Then bolus
introduction of fentanyl in dose 0.002 mg/kg and cysatracurium besylate. Analgesia
is provided with fentanyl. Artificial pulmonary ventilation is performed in moderate
overbreathing mode. Analgesia is maintained by fentanyl infused in dose 0.0012
mg/kg/hour. Wake-up test is carried out during the phase of metalwork implantation
accompanied with spinal deformation correction.
[009] By reference to RU application no. RU2466751C2 by State Educational
Institution of Higher Professional Education Amur State Medical Academy of
Roszdrav dated 2010-12-20, titled” Method of subdural anaesthesia as anaesthetic
management of cervical suturing surgery” discloses puncture point is anaesthetised
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by 0.5% bupivacaine. It is followed by puncture of a subdural space with the use of
a spinal needle at the level of L3-4, L4-5 from a medial approach. A local
anaesthetic is presented by hyperbaric 0.5% bupivacaine 0.8-1.2 ml. The patient is
kept seated for 10 minutes.
[010] By reference to CN application no. CN107049710A by Tianjin Medical
University General Hospital dated 2017-06-12, titled”A kind of lucky blue barre
syndrome subacute stage Rehabilitation training method” discloses a kind of lucky
blue barre syndrome subacute stage Rehabilitation training method, comprise the
following steps：A. the lower limb robot assisted gait training of daily 30
minutes；B. daily 30 minutes conventional motions training；C. daily 60 minutes
Functional Activities of OTs；D. step a c are carried out weekly 5 times, 8 weeks
totally；E. rehabilitation training result is estimated using the disabled scorings of
GBS, lower limb MRC scorings, Berg balance scales, Modified Barthel index scale,
gait parameter analysis, Electrophysiology, peripheral nerve ultrasonic
examination.Present invention reduces manpower consumption, it is ensured that
training time and quality, can partly substitute Traditional Rehabilitation training
method, the need for fully meeting clinical and scientific research, has broad
application prospects.
[011] However, none of the above-discussed inventions provides such a
Anaesthetic management method in guillain-barré syndrome undergoing total
hip replacement. The method comprises a plurality of steps.
OBJECTS OF THE INVENTION:
[012] Some of the objects of the present disclosure, which at least one embodiment
herein satisfies, are as follows.
[013] The main object of the present invention is to provide a Anaesthetic
management Method in guillain-barré syndrome undergoing total hip replacement.
[014] Another object of the invention, two iv cannula are inserted in the peripheral
veins (18 G on right and 20 G cannula on left).
[015] Another object of the invention, an oral endotracheal tube of size 7.0 is
inserted in the first intervention.
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[016] Another object of the invention, adequate bilateral air entry is confirmed
along with waveform capnography.
[017] Another object of the invention, injection Fentanyl 100 mcg is given for
analgesia. Anaesthesia is maintained on 50% oxygen 50% air and sevoflurane with
MAC 1.0 injection Atracurium 10 mg and injection Fentanyl 25 mcg intermittently
repeated for muscle relaxation and analgesia respectively.
[018] Other objects and advantages of the present disclosure will be more apparent
from the following description, which is not intended to limit the scope of the
present disclosure.
SUMMARY OF THE INVENTION:
[019] According to one aspect of our invention, anaesthetic management method in
guillain-barré syndrome undergoing total hip replacement comprising the steps of:
a) For post operative analgesia, a patient is administered an ultrasound guided
erector spinae plane block with the patient in right lateral position; b) A convex
ultrasound transducer is placed 4-6 cm lateral to L4 spinous process in a
longitudinal parasaggital orientation; c) The erector spianae muscle is identified
superficial to transverse process of L4 vertebra; d) Using an out-plane superior to
inferior approach a 22 gauge 10 cm needle is inserted to place the tip of needle into
the fascial planeon anterior aspect of erector spinae muscle; e) The needle tip is
localised by the visible fluid spread; wherein a total of injection Bupivacaine 0.25%
20 ml is injected; f) Patient is reversed with injection Neostigmine and injection
Glycopyrrolate after resumption of spontaneous respiration; g) The patient is then
extubated after achieving adequate tidal volume; h) The patient maintained spo2 of
99% on room air and is shifted to PACU for further care and management; i) Patient
is comfortable post operatively and the analgesia lasted for around 8 hours without
the need of an opiod.
[020] In another aspect of the invention, the patient did not require ventilator
support.
[021] In another aspect of the invention, during administration of an epidural
anesthesia leads to the interaction between the anesthetic agents and peripheral
nervous system myelin or local trauma to nerve roots which initiates a series of an
immunologic events.
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BRIEF DESCRIPTION OF DRAWINGS:
[022] Reference will be made to embodiments of the invention, examples of which
may be illustrated in accompanying figures. These figures are intended to be
illustrative, not limiting. Although the invention is generally described in the context
of these embodiments, it should be understood that it is not intended to limit the
scope of the invention to these particular embodiments.
[023] Figure 1: illustrates a Anaesthetic management method in guillain-barré
syndrome undergoing total hip replacement, as per an embodiment of the present
invention.
[024] The referral numerals in the figures refer to: 2, 3, 4, 5, 6, 7, 8, 9 - a
Anaesthetic management method steps.
BRIEF DESCRIPTION OF INVENTION:

[025] The present invention will now be described hereinafter with reference to the accompanying drawings, in which some, but not all embodiments of the invention are shown. While the following description details the preferred embodiments of the present invention is not limited in its application to the details of construction and arrangement of the parts illustrated in the accompanying drawings. With reference to the figures, the enclosed description and drawings are merely illustrative of preferred embodiments and represent several different ways of configuring the present invention. Although specific components, materials, configurations and uses of the present invention are illustrated and set forth in this disclosure, it should be understood that a number of variations to the components and to the configuration of those components described herein and in the accompanying figures can be made without changing the scope and function of the invention set forth herein.
[026] The present invention as illustrated in Figure 1 provides another embodiment of the invention which includes a Anaesthetic management method in guillain-barré syndrome undergoing total hip replacement.
[027] In another embodiment, a 51 year old female with a history of Guillain-Barré syndrome (GBS) is posted for left sided total hip replacement. She has a history of weakness in both the lower limbs which is followed by a sudden fall after which she is diagnosed with Guillain-Barré syndrome (GBS). She underwent intravenous immunoglobulins for 7 days after which her symptoms resolved significantly. On examination at present she has mild numbness and decreased sensations in the fingers of the upper limb. On general physical examination no other neurological or organic abnormality is found. All the routine investigations and airway assessment were within the normal limits.
[028] In another embodiment, the surgery is planned under general anaesthesia. Patient is taken in the operating theatre and standard monitors were attached. Two iv cannula were inserted in the peripheral veins (18 G on right and 20 G cannula on left). Preoxygenation is done with 100% O2 followed by induction using injection Propofol 140 mg injection Atracurium 25mg. Oral endotracheal tube of size 7.0 is inserted in the first intervention. Adequate bilateral air entry is confirmed along with waveform capnography. Injection Fentanyl 100 mcg is given for analgesia. Anaesthesia is maintained on 50% oxygen 50% air and sevoflurane with MAC 1.0 injection Atracurium 10 mg and injection Fentanyl 25 mcg intermittently repeated for muscle relaxation and analgesia respectively. Cumulative blood loss during the surgery is approximately 950 ml which is replaced by transfusion of one unit packed red blood cells and one colloid. Rest of the surgery is eventful. Total duration of surgery is around three hours and thirty minutes.
[029] In another embodiment, for post operative analgesia patient is administered an ultrasound guided erector spinae plane block with the patient in right lateral position. A convex ultrasound transducer is placed 4-6 cm lateral to L4 spinous process in a longitudinal parasaggital orientation. The erector spianae muscle is identified superficial to transverse process of L4 vertebra. Using an out-plane superior to inferior approach a 22 gauge 10 cm needle is inserted to place the tip of needle into the fascial planeon anterior aspect of erector spinae muscle. The needle tip is localised by the visible fluid spread. A total of injection Bupivacaine 0.25% 20 ml is injected. Patient is reversed with injection Neostigmine and injection Glycopyrrolate after resumption of spontaneous respiration. The patient is then extubated after achieving adequate tidal volume. The patient maintained spo2 of 99% on room air and is shifted to PACU for further care and management. Patient is comfortable post operatively and the analgesia lasted for around 8 hours without the need of an opiod.
[030] The present disclosure described herein above has several technical advantages including, but not limited to,
? patient did not require ventilator support.
? meticulous planning and its execution is of utmost importance for safety of the patients undergoing surgery.
[031] The disclosure has been described with reference to the accompanying embodiments herein and the various features and advantageous details thereof are explained with reference to the non-limiting embodiments in the following description. Descriptions of well-known components and processing techniques are omitted so as to not unnecessarily obscure the embodiments herein.
[032] The foregoing description of the specific embodiments so fully revealed the general nature of the embodiments herein that others can, by applying current knowledge, readily modify and/or adapt for various applications such specific embodiments without departing from the generic concept, and, therefore, such adaptations and modifications should and are intended to be comprehended within the meaning and range of equivalents of the disclosed embodiments. It is to be understood that the phraseology or terminology employed herein is for the purpose of description and not of limitation. Therefore, while the embodiments herein have been described in terms of preferred embodiments, those skilled in the art will recognize that the embodiments herein can be practiced with modification within the scope of the embodiments as described herein.

We Claim:

1. A Anaesthetic management method in guillain-barré syndrome undergoing total hip replacement comprising the steps of: a) For post operative analgesia, a patient is administered an ultrasound guided erector spinae plane block with the patient in right lateral position; b) A convex ultrasound transducer is placed 4-6 cm lateral to L4 spinous process in a longitudinal parasaggital orientation; c) The erector spianae muscle is identified superficial to transverse process of L4 vertebra; d) Using an out-plane superior to inferior approach a 22 gauge 10 cm needle is inserted to place the tip of needle into the fascial planeon anterior aspect of erector spinae muscle; e) The needle tip is localised by the visible fluid spread; wherein a total of injection Bupivacaine 0.25% 20 ml is injected; f) Patient is reversed with injection Neostigmine and injection Glycopyrrolate after resumption of spontaneous respiration; g) The patient is then extubated after achieving adequate tidal volume; h) The patient maintained spo2 of 99% on room air and is shifted to PACU for further care and management; i) Patient is comfortable post operatively and the analgesia lasted for around 8 hours without the need of an opiod.
2. The Anaesthetic management method in guillain-barré syndrome undergoing total hip replacement claimed in claim 1, wherein the patient did not require ventilator support.
3. The Anaesthetic management method in guillain-barré syndrome undergoing total hip replacement claimed in claim 1, wherein during administration of an epidural anesthesia leads to the interaction between the anesthetic agents and peripheral nervous system myelin or local trauma to nerve roots which initiates a series of an immunologic events.