Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Role of interventional radiology in paediatric liver transplantation(Sri Lanka Medical Association, 2023) Fernando, M.; Gunetilleke, B.; Tillakaratne, S.; Siriwardana, R.C.; Appuhamy, W.N.D.P.C.; Padmasiri, U.G.M.INTRODUCTION: Interventional radiology advances have rendered it attainable to treat many of the complications of liver disease in a minimally invasive manner, and they play a major role in liver transplantation. OBJECTIVES: We aimed to assess the role of interventional radiology in a cohort of paediatric liver transplant patients. METHODS: Thirteen paediatric patients underwent liver transplantations from July 2020–February 2023 at Colombo-North Teaching Hospital, Ragama. Seven patients (53.84%) required special interventional radiological procedures. The need for an interventional radiological procedure was decided by a multidisciplinary team. A retrospective database was maintained with demographic and liver transplant data. RESULTS: Four patients (57.14%) requiring radiological intervention underwent procedures involving the thoracic cavity, and 5 patients (71.42%) who required radiological intervention underwent procedures involving the abdominal cavity. Two patients (28.57%) out of the seven who had interventional radiological procedures went through both abdominal and thoracic radiological interventions. As abdominal radiological interventions, splenic artery embolization (20%), hepatic venous stenting (20%), subhepatic drain placement (20%), and two abdominal pigtail drain insertions (40%) have been done. Four patients underwent pigtail insertion, which was performed as a thoracic radiological intervention. CONCLUSIONS: Interventional radiology plays a crucial role in the management of paediatric post-liver transplantation patientsItem Novel technique for uninterrupted confirmation of endotracheal tube position for awake fiberoptic intubation(Elsevier B.V, 2020) Kerner, V.; Gunetilleke, B.; Fernando, R.Misplacement of an endotracheal tube in a patient with a difficult airway is catastrophic. Currently used techniques do not permit simultaneous bronchoscopic and capnographic confirmation of tube placement. We report a novel technique for seamless monitoring of the endotracheal tube position in the tracheobronchial tree during Awake Fibre Optic Intubation (AFOI). The simple modification described improves the safety profile of AFOI in several ways. The modification allows an overlap between the bronchoscopic viewing of the endotracheal tube in the trachea and the appearance of the typical wave on the capnograph. It only requires an endotracheal tube connected to a catheter mount. The bronchoscope is then introduced via the port on the catheter mount. The tube-catheter mount unit is secured to the scope (Figure 1). A ventilator circuit with attached capnograph adapter is connected to the catheter mount once the endotracheal tube is advanced into the trachea. Ventilation is then initiated. Appearance of the characteristic wave on capnograph confirms the correct position before the extraction of the bronchoscope Migration of the tube into the oesophagus is unnoticed until the bronchoscope is completely removed from the trachea in 5±10% of AFOIs1,2. Displacement of endotracheal tube into the oesophagus despite the bronchoscope tip being positioned in the trachea has been described3. Resistance that is felt as the tube is advanced over the mid part of the scope looped into the oesophagus may be misinterpreted as the tube tip impinging on the arytenoid cartilages3. The tube slides into the oesophagusas the scope is extracted. This usually occurs before capnographic confirmation is possible3. The technique we propose will be useful since ventilation is initiated with the scope in-situ. Loss of the capnographic trace is evidence of misplacement of the tube, though the bronchoscope is within the trachea. We propose this should be the standard of care and should be included in the AFOI training protocols.