Congenital lobar emphysema (CLE) or congenital lobar over inflation is a rare pulmonary anomaly that causes respiratory distress in neonates. CLE presents significant challenges in diagnosis and management. We reported a case of two-month old infant with respiratory distress and pneumonia related to CLE affecting the left upper lobe. Lobectomy was performed under general anaesthesia with spontaneous and controlled lung Ventilation. The case was challenging, as it involved careful and planned anaesthetic management of lung separation as well as prevention of hyperventilation of the un-involved lung.
Archive for the ‘ Anaesthesiology ’ Category
Awake craniotomy for eloquent area surgery can be managed with different anaesthetic techniques ranging from local anaesthetic with or without intravenous sedation to intermittent general anaesthesia with or without instrumentation of the airway, known as awake—awake—awake, asleep—awake—awake and asleep—awake—asleep craniotomy. We present a case of 34 year old male who was diagnosed to have Right frontal low grade glioma. Tumor resection was planned and decided to perform craniotomy with the patient being awake during the procedure, to allow intraoperative cortical mapping in order to preserve the language and motor functions.
Objectives: A comparative study to evaluate effect of pre-operative administration of oral aspirin and precurarization (with pancuronium) in prevention of suxamethonium induced myalgia.
Methodology Design and setting: Tertiary care teaching hospital. Subjects: The present study was carried out on 75 patients in age group of 16-65 years belonging to ASA grade I or II. The cases undergoing surgery under general anaesthesia where endotracheal intubation was considered desirable and in whom aspirin was not contraindicated.
Results: In entire case series of 75 patients, 52 (69.3%) had fasciculation. Out of them Group I patients has least i.e. 24% while group II and Group III had equal i.e 92%of patients having fasciculation.
Conclusion: Preoperative aspirin 600mg orally 1 hr before operation effectively reduces Suxamethonium induced pain and avoid complications associated with pretreatment with non-depolarising agents.
Key words: Oral aspirin, Suxamethonium, Fasciculation.
Abstract: Armored tubes are being widely used in anaesthesia practise where surgeries involving procedures in which kinking is anticipated. Kinking of armored tubes is uncommon but it can happen when a reusable tube is used and there have been reports of armored tube kinking both intraorally and extraorally. Hence prompt anticipation of tube kinking is mandatory even when armored tubes are used. Herewith we report a case of unusual complication of armored tube kinking in prone position.
Abstract:Context: The use of ultrasound in regional anaesthesia has resulted in reduction in local anaesthetic volume and adverse effects.Aim : This study aims to compare the quality of analgesia and incidence of adverse effects using two different volumes of 0.5 % bupivacaine for clavicular surgeries by ultrasound guided combined interscalene and superficial cervical plexus block.Settings and Design: randomized controlled double blinded interventional study Methods and Material: 60 patients undergoing clavicular surgery were randomized to receive ultrasound guided interscalene block of either 15 ml (group L) or 25 ml (Group H) of 0.5 % bupivacaine and 10 ml of 0.25 % bupivacaine for superficial plexus block. Both the groups were assessed for quality of intraoperative and postoperative analgesia by sensory, motor block. Hemidiaphragmatic paresis was assessed by ultrasound guided diaphragmatic movement.
ABSTRACT Endotracheal intubation in patients with soft tissue defect due to a failed flap from previous surgery can be done with obturating the defect for mask ventilation. Here we report a case of soft tissue deficit with otherwise uncompromised of upper airway. This was done as an alternate approach to maintain a definitive airway
ABSTRACT Thalassaemias are a group of haematological disorders characterized by deficient or total lack of normal haemoglobin chains with extra vascular haemolysis and ectopic marrow expansion leading to anaemia, splenomegaly and bony abnormalities. Survival is associated with various multisystem complications primarily caused by chronic anaemia, iron overload, adverse effects of chelation, and transfusion associated infections We report a five and half years old child with beta thalassaemia major diagnosed at the age of one and half years receiving blood transfusions every three weeks on chelation therapy for iron overload. This child presented to the dental outpatient department with extensive dental caries and was scheduled for a total mouth rehabilitation under general anaesthesia. Due to early diagnosis, regular blood transfusion and chelation therapy for iron overload this child did not have obvious oro facial deformities and the typical facial appearance (chipmunk face)
ABSTRACT Sir Hernandez Altemir had described in 1986 that submental intubation is a useful technique as an alternative to tracheostomy in selected patients allowing undisturbed access to oral and nasal airways and with a good dental occlusion. We report a case of haemangioma right upper lip extending to the right nasolabial region for which submental orotracheal intubation was done. This is a rare indication in contrast to the usual indication of submental intubation for complex craniomaxillofacial trauma cases. The submental approach for intubation allowed an unhindered surgical approach and ease of maintaining the airway thereby avoiding the need for tracheostomy.
AbstracBackground: Acute normovolaemic haemodilution (ANH) is one of the types of autotransfusion which can be used as an alternative method of replacing lost blood during surgery. Normovolaemia has to be maintained during ANH by administering sufficient volume of haemodiluents either crystalloids or colloids. Aim: To compare prospectively the effects of two haemodiluents, Crystalloid (Ringer lactate) and Colloid (Polygeline) in moderate Acute Normovolaemic haemodilution (ANH). Methodology: 50 patients(ASA physical status I or II) undergoing elective gynaecological surgeries with an estimated prediction of blood loss from 500-750ml in each patient were divided into two groups of 25 each. In Group R – Ringer lactate in the ratio of 3:1 and in Group H –Polygeline (Haemaccel) in the ratio of 1.5:1 were used during haemodilution. Heart rate, systolic BP, diastolic BP, SPO2 and Haematocrit were observed before and after haemodilution, before and after retransfusion of the blood. All the data were analyzed using Student’s ‘t’ test and P values < 0.05 were taken to be significant. Results: During all the stages there were no statistical differences in heart rate, systolic BP, Diastolic BP, SPO2, Haematocrit and surgical blood loss between the two groups. Conclusion: We conclude that during moderate acute normovolaemic haemodilution(ANH) either Ringer’s lactate or Polygeline(Haemaccel) can be used as replacement fluid as both are comparable in terms of haemodynamic stability, oximetric and haematological profiles.
Abstract A forty two year old male, a chronic smoker, was posted for lumbar discectomy at L3-4 level. General anaesthesia was administered and was maintained with isoflurane and nitrous oxide with oxygen. On turning the patient to prone position, the patient developed hypoxaemia. Air entry was reduced on the left lung field along with a rise in peak inspiratory pressure. CT scan of the thorax showed left sided pneumothorax, pneumomediastinum and subcutaneous emphysema. A chest tube thoracostomy was done and the patient made an uneventful recovery. We recommend that pneumothorax should be considered a possibility in any patient who has unexplained hypoxaemia during general anaesthesia and exercise caution while using nitrous oxide in chronic smokers.