Journal of Clinical Anaesthesiology: Open Access

Above all else I express genuine thankfulness to all authors and reviewers of the Journal of Clinical Anesthesiology: Open Access (JCAO) in the interest of the whole publication board and the publisher. It was with the negligible co-activity, excitement, and soul of the authors and reviewers we could make JCAO a fantastic achievement. Authors have been a genuine inspiration and key in setting up JCAO among one of the best journal for publication in the subject of Anesthesiology and Pharmacovigilance. I express gratitude toward them all in considering and trusting JCAO as the stage for publishing their significant work. I additionally thank all authors for their caring co-activity stretched out during the different phases of processing of the articles in JCAO.

Organizing Committee invites all the participants from all over the world to attend “6th International Conference on Anesthesia” during September 22-23, 2021 in Zurich, Switzerland on the theme “Gaining a broader practical understanding of global approaches used in Anesthesia” which includes prompt Keynote presentations, Oral talks, Poster presentations and Exhibitions.

Anesthesia 2021 which aims to gather the most elegant societies and industries along with the renowned and honorable persons form top universities across the globe. Anesthesia 2021 on behalf of its organizing Committee welcomes all the Anesthesia and Anesthesiology researchers, industrialists, doctors, young scientists as well as student and corporate delegates to participate and to have a great experience

This paints a picture of a woman just about ready to bring a new life into the world. Yet such a wonderful childbirth experience can bring one memories of pain, fear, and joy all packaged into one. Childbirth is an experience that is both exciting and painful for every woman. This is a review of the development of obstetric anesthesia and puts in perspective the history of obstetric anesthesia in both the western and eastern medicine, and how each has contributed to the other.

In western medicine, the introduction of modern anesthesia in obstetrical practice has been credited to Sir James Y. Simpson who used ether in childbirth on January 19^th of 1847. A few more attempts led him to chloroform which was found to be stronger and better than ether. (Heaton, 1946)   By the turn of the 20^th century, ether and chloroform were ubiquitous in childbirth on both sides of the Atlantic Ocean. (Caton, 2004)  Despite this medical breakthrough, however, the British criticized that ether and chloroform not only increased the risk of hemorrhage and infection but had detrimental effects on the newborn. (Edwards & Jackson, 2017) Some would argue that the pain of childbirth was inseparable from the function of the uterus, and to suppress that pain would inhibit labor. (Gibson, 2017) Still, others would argue that to relieve pain during childbirth was to counter the biblical teaching that women would suffer in childbirth after Eve’s sin and that anesthesia would open the door to unnecessary procedures without the patient’s consent.  (Gibson, 2017)   Figure 1 shows a timeline on the development of obstetric anesthesia in the western part of the globe.

Uterine leiomyomas, commonly called fibroids are benign tumours of uterine myometrium composed of smooth muscle with variable amount of connective tissue. It is the commonest tumour of the female pelvic organ. ¹. As it is vascular tumour, many a times Myomectomy leads severe intraoperative blood loss. It is estimated that the average volume of blood loss during abdominal myomectomy ranges between 200 – 400 ml, ^2,3,4 with blood loss greater than 1000 ml considered as major blood loss.⁵ Vasopressin is a synthetic analogue of the anti-diuretic hormone, has a V1 receptor agonistic action thereby causes vasoconstriction . Intramyometrial injection  of vasopressin helps to reduce significant intraoperative blood loss.  However, it is not devoid of side effects and sometimes might cause very serious  complications like  arrhythmias, bradycardia, pulmonary oedema, and cardiac arrest. Here we  are presenting a case report of sudden severe bradycardia caused by  intramyoma diluted vasopressin injection and discussion on management of such patients.

Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by radiological diffuse bilateral lung infiltration, decreased respiratory compliance and severe hypoxemia. The major goal in ARDS is correction of life threatening hypoxemia and concurrent improvement of respiratory mechanics. Mechanical ventilation is invariably required in this subset of patients with aim of providing optimum oxygenation and at the same time strategies to prevent ventilator-induced lung injury (VILI). While lung protective strategies remain the main stay of treatment, early prone ventilation plays a crucial role to improve ventilation perfusion mismatch.

Prone ventilation with or without neuromuscular blocking agents (NMBAs) are distinctly indicated in severe refractory ARDS to achieve better expansion of the dorsal lung regions with consequent improvement in oxygenation. However, prone positioning requires advance competence level for attending critical care physicians and nursing staff due to the inherent risk associated with positioning. We report the successful management of an adult mechanically ventilated patient having scrub typhus induced severe refractory ARDS, undergoing early prone ventilation in conjunction with recommended ventilation strategies