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Devic’s disease: A devil’s trap for the Anesthesiologist: A case report 德维奇氏病麻醉师的魔鬼陷阱:病例报告
Pub Date : 2024-06-15 DOI: 10.18231/j.ijca.2024.049
Roshin Binoy, Bincy V. Thomas, Sheela Verghese
Neuromyelitis optica spectrum of disorder (NMOSD) is a rare autoimmune inflammatory relapsing astrocytopathy due to immunoglobulin against aquaporin 4 (AQP4) receptor. It is characterized by demyelination of the spinal cord and optic nerve. The vulnerability of demyelinated neurons to local anesthetics and increased response to neuromuscular blocking agents make the choice of anesthesia challenging. The rarity of the disease has made the literature scarce, especially when it comes to those undergoing surgeries and their anesthetic implications. We report the case of a 54-year-old patient with NMOSD who underwent modified radical mastectomy for carcinoma breast under general anesthesia. The use of multimodal analgesia for pain management and the avoidance of muscle relaxants resulted in an uneventful perioperative period in this patient.
神经脊髓炎视神经谱系障碍(NMOSD)是一种罕见的自身免疫性炎症复发性星形胶质细胞病,是由针对水汽素 4(AQP4)受体的免疫球蛋白引起的。其特征是脊髓和视神经脱髓鞘。脱髓鞘神经元易受局部麻醉剂的影响,对神经肌肉阻断剂的反应也会增加,这使得麻醉的选择具有挑战性。这种疾病的罕见性使得相关文献很少,尤其是关于手术及其麻醉影响的文献。我们报告了一例 54 岁的 NMOSD 患者,她在全身麻醉下接受了改良根治性乳腺癌切除术。由于采用了多模式镇痛,并避免使用肌肉松弛剂,该患者的围手术期十分顺利。
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引用次数: 0
Successful outcome in pregnancies with eisenmenger syndrome for category 1 LSCS: A case series 患有艾森曼格综合征的 1 类 LSCS 孕妇的成功结局:病例系列
Pub Date : 2024-06-15 DOI: 10.18231/j.ijca.2024.044
Mudhabir Ashraf, U. Salmani, Tantry Tariq Gani, Muneeb Ur Rashid
PAH associated eisemnenger syndrome is a congenital heart diseases with bidirectional or reversed shunt. The maternal mortality in this syndrome is very high 30-50%. We present a case series of 3 patients with eisemnenger syndrome with successful materno-faetal outcome of patients under general anaesthesia for category 1 LSCS. The focus of anesthetic management was to preserve SVR (systemic vascular resistance) to PVR (pulmonary vascular resistance) ratio.
PAH 相关 eisemnenger 综合征是一种双向或反向分流的先天性心脏病。该综合征的孕产妇死亡率高达 30%-50%。我们介绍了 3 例 eisemnenger 综合征患者的系列病例,这些患者在 1 类 LSCS 的全身麻醉下均获得了成功的母胎结局。麻醉管理的重点是保持 SVR(全身血管阻力)与 PVR(肺血管阻力)的比率。
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引用次数: 0
Anaesthetic management of post-PTCA cardiac tamponade from cath lab to cardiothoracic operating theater 从心导管实验室到心胸外科手术室的 PTCA 术后心脏填塞的麻醉管理
Pub Date : 2024-06-15 DOI: 10.18231/j.ijca.2024.050
Ameerunnisha Begum, Niranjni Sivadoss, Lakshmi Ramakrishnan
Cardiac tamponade is a medical emergency characterized by the accumulation of fluid in the pericardial sac, exerting pressure on the heart and impairing its ability to pump blood effectively. This condition can result from various causes, including trauma, infection, malignancy, or complications of medical procedures such as percutaneous coronary interventions (PCI) like percutaneous transluminal coronary angioplasty (PTCA). The anaesthesiologists play a pivotal role as peri operative physicians in the catheterization laboratory and intensivists in the ICU in prompt recognition and intervention which is crucial to prevent hemodynamic collapse and improve patient outcomes. In this case, a female in her fifties with a history of previous PCI developed cardiac tamponade shortly after undergoing PTCA. Despite immediate stabilization attempts in the catheterization laboratory, the patient's condition deteriorated rapidly, necessitating emergency pericardiocentesis and subsequent thoracotomy for definitive management. The successful outcome of this case underscores the importance of early recognition, rapid intervention, and a multidisciplinary approach in managing cardiac tamponade post-PTCA.
心脏填塞是一种医学急症,其特点是心包囊积液,对心脏产生压力,影响其有效泵血的能力。造成这种情况的原因有很多,包括外伤、感染、恶性肿瘤或经皮冠状动脉介入治疗(PCI)(如经皮冠状动脉腔内成形术(PTCA))等医疗程序的并发症。麻醉科医生作为导管室的围手术期医生和重症监护室的重症监护医生,在及时识别和干预方面发挥着关键作用,这对于防止血流动力学衰竭和改善患者预后至关重要。在本病例中,一名 50 多岁的女性患者既往有 PCI 病史,在接受 PTCA 术后不久出现心脏填塞。尽管导管室立即尝试稳定病情,但患者的病情迅速恶化,不得不进行紧急心包穿刺,随后进行开胸手术以明确治疗。本病例的成功结果强调了早期识别、快速干预和多学科方法在处理 PTCA 术后心脏填塞的重要性。
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引用次数: 0
Comparison of efficacy of intrathecal hyperbaric ropivacaine and hyperbaric bupivacaine in terms of enhanced recovery after surgery (ERAS) for ACL reconstructions 在前交叉韧带重建手术(ERAS)中,比较鞘内高压罗哌卡因和高压布比卡因在增强术后恢复(ERAS)方面的疗效
Pub Date : 2024-06-15 DOI: 10.18231/j.ijca.2024.031
N. Panse, Noopur Dasmit Singh, Payoja Narendra Khadpekar, Varun Raj Dubey
: Bupivacaine is the drug of choice in spinal anaesthesia (SA), while Ropivacaine with its comparatively shorter duration of motor block allows early mobilization post ACL reconstruction surgery which is a crucial factor in Early Recovery after Surgery. : In this randomized double-blind comparative study of a total of 60 patients irrespective of gender undergoing ACL reconstruction surgery were studied. After Administration of SA to group R (2.5ml of 0.75% Heavy Ropivacaine) & group B (2.5ml of 0.5% Bupivacaine) both were compared for their post-operative effects with Bromage score, Aldrete score & Visual Analogue Score. : The time required for complete regression of motor blockade in group R (144.5+26.1 mins) < group B (181±21.3mins) which allowed for early mobilization which over all provides better and faster recovery.: Hyperbaric Ropivacaine when compared to Bupivacaine promises better results in terms of early ambulation and intraoperative hemodynamic stability promoting ERAS in patients undergoing ACL reconstruction surgeries. Promoting ERAS policy will reduce the duration of hospital stay, thereby improving the cost-effectiveness of health services.
:布比卡因是脊髓麻醉(SA)的首选药物,而罗比卡因的运动阻滞持续时间相对较短,可以在前交叉韧带重建手术后尽早活动,这是术后早期恢复的关键因素。 在这项随机双盲对比研究中,共有 60 名患者(不分男女)接受了前交叉韧带重建手术。R 组(2.5 毫升 0.75% 重型罗哌卡因)和 B 组(2.5 毫升 0.5% 布比卡因)在使用 SA 后,通过 Bromage 评分、Aldrete 评分和视觉模拟评分比较两组的术后效果。 R 组运动阻滞完全消退所需时间(144.5+26.1 分钟)< B 组(181±21.3 分钟),这使得患者可以尽早活动,从而更好更快地恢复:与布比卡因相比,高压氧罗哌卡因可使接受前交叉韧带重建手术的患者在早期活动和术中血流动力学稳定方面获得更好的效果,从而促进ERAS。推广 ERAS 政策将缩短住院时间,从而提高医疗服务的成本效益。
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引用次数: 0
Paediatric pulmonary hypertension due to congenital heart disease in non-cardiac surgery: Anaesthetic implications 非心脏手术中先天性心脏病导致的小儿肺动脉高压:麻醉影响
Pub Date : 2024-06-15 DOI: 10.18231/j.ijca.2024.040
Iti Shri, Leena Tayshete, Jasvinder K Kohli, R. Kashav
Paediatric patients with pulmonary hypertension associated with Congenital Heart Disease (PH-CHD) are frequently encountered in non-cardiac surgical settings. Although the pharmacological and surgical management of the underlying CHD in the group has improved yet its management remains challenging due to associated high morbidity and mortality. The dilemma prevails more so because of the dearth of adequate literature describing its pathophysiology and management in non-cardiac surgical settings. There are no specific guidelines pertaining to paediatric PH-CHD care, and the precepts have been extrapolated from adult studies and guidelines. This review article intends to apprise the pathophysiology of PH-CHD, its management, and its perioperative care with special emphasis on pulmonary vascular hypertensive crisis in these patients posted for non-cardiac procedures.
与先天性心脏病(PH-CHD)相关的肺动脉高压儿科患者经常在非心脏外科环境中遇到。尽管对这类患者潜在的先天性心脏病的药物和手术治疗有所改善,但由于相关的高发病率和高死亡率,其治疗仍然具有挑战性。由于缺乏足够的文献来描述非心脏手术环境中的病理生理学和治疗方法,因此这种困境更加普遍。目前还没有关于儿科 PH-CHD 护理的具体指南,相关概念都是从成人研究和指南中推导出来的。这篇综述文章旨在介绍 PH-CHD 的病理生理学、处理方法和围手术期护理,并特别强调这些患者在接受非心脏手术时出现的肺血管性高血压危象。
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引用次数: 0
Anaesthetic challenges in a patient with eisenmenger syndrome: A case report 艾森曼格综合征患者的麻醉挑战:病例报告
Pub Date : 2024-03-15 DOI: 10.18231/j.ijca.2024.018
Priya Chandran, Shiril Ashraf, Sheela Verghese
The term Eisenmenger syndrome describe a large left-to-right cardiac shunt. Occur in 8% of patients with congenital heart disease. Pregnancies carries very high risk of mortality and premature delivery. 20-30% pregnancies result in spontaneous abortion and premature delivery. Pulmonary microembolism and macroembolism have caused peripartum maternal death even after delivery. Anaesthetic management is challenging due to the patho-physiology of the shunt. Our case report is a 27-year-old female known case of Eisenmenger syndrome with chronic thromboembolism presented with inevitable abortion scheduled to undergo emergency evacuation under general anaesthesia.
艾森曼格综合征(Eisenmenger syndrome)是指心脏左向右大分流。8%的先天性心脏病患者会出现这种情况。妊娠有很高的死亡率和早产风险。20-30% 的妊娠会导致自然流产和早产。肺部微栓塞和大栓塞甚至会在分娩后导致围产期产妇死亡。由于分流的病理生理学原因,麻醉处理具有挑战性。我们的病例报告是一例已知患有艾森曼格综合征并伴有慢性血栓栓塞的 27 岁女性病例,她因不可避免的流产而计划在全身麻醉下进行紧急排空。
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引用次数: 0
Anaesthetic management of a case of Takayasu arteritis: A case report 一例高安动脉炎的麻醉处理:病例报告
Pub Date : 2024-03-15 DOI: 10.18231/j.ijca.2024.023
R. Wadhwa, Ehtesham Naqvi, Suman Keshav, S. Virmani
Takayasu's arteritis (TA) is a rare disease characterized by chronic progressive pan-endarteritis involving large blood vessels with resultant feeble pulsations in involved arteries. Therefore, it is also referred as pulseless disease. The challenges for anaesthesia management includes uncontrolled hypertension, invasive arterial monitoring, central nervous system monitoring and end-organ dysfunction. We present successful management of a middle-aged female diagnosed with TA posted for aorto-carotid graft. The anaesthesia management and complications encountered are highlighted.
高安氏动脉炎(TA)是一种罕见疾病,其特点是慢性进行性泛动脉炎累及大血管,受累动脉搏动微弱。因此,它也被称为无脉症。麻醉管理面临的挑战包括无法控制的高血压、有创动脉监测、中枢神经系统监控和终末器官功能障碍。我们介绍了一名被诊断患有 TA 的中年女性接受主动脉-颈动脉移植手术的成功案例。重点介绍麻醉管理和遇到的并发症。
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引用次数: 0
Carcinoid syndrome: Innovative anesthetic approach utilizing erector spinae plane block 类癌综合征:利用竖脊肌平面阻滞的创新麻醉方法
Pub Date : 2024-03-15 DOI: 10.18231/j.ijca.2024.019
Ojaswani Rai Sood, Mohmad Salim
A 57-year-old female with history of carcinoid syndrome along with extensive liver metastases presented for a right sided mastectomy and implant insertion for breast cancer. Preoperative optimization included an octreotide infusion and anxiolysis, as well as planning a cardiostable anaesthetic that avoided any crisis stressors. Ultrasound guided thoracic (T4) ESP block using 0.2% Ropivacaine was given under propofol sedation followed by remifentanil and propofol anaesthesia. Octreotide infusion along with boluses was used to treat hypotension and bradycardia intraoperatively. The combination of perioperative octreotide administration, intraoperative remifentanil and propofol anaesthesia and ESP block provided satisfactory anaesthesia. The block was effective for 36 hours post-operatively and the patient was discharged 48 hours post admission. We suggest that a novel interfascial plane block, ESP block is a useful addition to the armamentarium of the anaesthetist in the management of a patient with carcinoid syndrome with an aim to decrease dependence on morphine and preventing conversion to chronic pain.
一名 57 岁的女性因乳腺癌接受了右侧乳房切除术和植入物手术,她既有类癌综合征病史,又有广泛的肝转移。术前优化措施包括输注奥曲肽和抗焦虑药,以及计划进行心脏稳定麻醉,以避免任何危机应激因素。在异丙酚镇静的情况下,使用0.2%罗哌卡因在超声引导下进行胸廓(T4)ESP阻滞,然后使用瑞芬太尼和异丙酚麻醉。术中使用奥曲肽输注和栓剂治疗低血压和心动过缓。围术期奥曲肽给药、术中瑞芬太尼和异丙酚麻醉以及ESP阻滞的组合提供了令人满意的麻醉效果。阻滞在术后 36 小时内有效,患者在入院 48 小时后出院。我们认为,在类癌综合征患者的治疗中,ESP阻滞这种新型筋膜间平面阻滞是麻醉师的有效补充,其目的是减少患者对吗啡的依赖,并防止患者转为慢性疼痛。
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引用次数: 0
A systematic review on efficacy of dexmedetomidine on emergence agitation after nasal surgeries 右美托咪定对鼻腔手术后出现躁动的疗效系统综述
Pub Date : 2024-03-15 DOI: 10.18231/j.ijca.2024.014
Ritu Medatwal, Anil Garg
Dexmedetomidine has sympatholytic, soothing, pain relieving vasoconstrictive and, sedative impacts, which might assist with forestalling hypotension. This study intended to play out an orderly survey of the writing and explore the viability of dexmedetomidine on perioperative dreariness following nasal medical procedure. We looked the electronic Embase, Cochrane, MEDLINE, and PubMed data sets. Moreover, each significant article's and book's reference index was totally looked. Included were the expressions "Dexmedetomidine" [MeSH] "development disturbance, "[MeSH]", nasal medical procedure" [MeSH]" and general aneasthesia" [MeSH]. This survey shows that the fundamental organization of dexmedetomidine can diminish intraoperative blood misfortune, careful time, postoperative torment and the rate of development unsettling.
右美托咪定具有交感溶解、舒缓、止痛、收缩血管和镇静的作用,可能有助于防止低血压。本研究旨在对相关文献进行有序调查,探讨右美托咪定对鼻腔手术后围手术期乏力的可行性。我们查阅了Embase、Cochrane、MEDLINE和PubMed的电子数据集。此外,我们还查阅了每篇重要文章和书籍的参考文献索引。其中包括 "右美托咪定"[MeSH]"发育障碍"[MeSH]"、"鼻腔医疗程序"[MeSH]"和 "全身麻醉"[MeSH]。这项调查表明,右美托咪定的基本组织可以减少术中的血祸、小心时间、术后痛苦和发展不安的发生率。
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引用次数: 0
Difficult mask ventilation: An objective criterion 困难面罩通气:客观标准
Pub Date : 2024-03-15 DOI: 10.18231/j.ijca.2024.016
K. Chaudhary, Vishrantkumar K Kushal Shetty
Effective mask ventilation plays a critical role in safe management of airway before intubation or after failed intubation. Mask ventilation (MV) is the primary technique of ventilation before tracheal intubation or insertion of any airway device. Its most unique role however, is as a rescue technique for ventilation should tracheal intubation fail or prove difficult. The ability to establish adequate MV has, therefore, become a major branch point in any difficult airway algorithm. Despite it being an important skill, MV has received little attention in the extensive body of literature and book chapters addressing airway management when compared to laryngoscopy and intubation. At present, there is no standard definition for Difficult Mask Ventilation (DMV) that is based on precise and objective criterion. The authors propose a simple objective criterion to categorize difficult mask ventilation based on the best monitoring parameters.
有效的面罩通气在插管前或插管失败后的气道安全管理中起着至关重要的作用。面罩通气(MV)是气管插管或插入任何气道装置前的主要通气技术。然而,其最独特的作用是在气管插管失败或困难时作为通气的抢救技术。因此,建立适当 MV 的能力已成为任何困难气道算法的一个主要分支点。尽管 MV 是一项重要技能,但与喉镜检查和插管相比,MV 在有关气道管理的大量文献和书籍章节中很少受到关注。目前,对困难面罩通气(DMV)还没有基于精确客观标准的标准定义。作者提出了一个简单的客观标准,根据最佳监测参数对困难面罩通气进行分类。
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引用次数: 0
期刊
Indian Journal of Clinical Anaesthesia
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