D. Singla, Kasari Masaipeta, T. Mageshwaran, M. Mangla
Subglottic narrowing or alteration can cause difficulty in tracheostomy. Although no specific technique has been mentioned in the literature, various procedures have been advocated to increase accuracy and to minimize complications. Here, we describe a case where flexible intubation videoscope was used for successful location of tracheal lumen and insertion of the tracheostomy tube.
{"title":"Flexible intubation videoscope-guided replacement of tracheostomy tube in a carcinoma larynx patient with extensive subglottic involvement","authors":"D. Singla, Kasari Masaipeta, T. Mageshwaran, M. Mangla","doi":"10.4103/KAJ.KAJ_19_18","DOIUrl":"https://doi.org/10.4103/KAJ.KAJ_19_18","url":null,"abstract":"Subglottic narrowing or alteration can cause difficulty in tracheostomy. Although no specific technique has been mentioned in the literature, various procedures have been advocated to increase accuracy and to minimize complications. Here, we describe a case where flexible intubation videoscope was used for successful location of tracheal lumen and insertion of the tracheostomy tube.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78168289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Laryngoscopy and endotracheal intubation alter cardiovascular physiology both via reflex responses and physical presence of an endotracheal tube (ETT). Stress response caused by laryngoscopic endotracheal intubation may be harmful for the coronary or cerebral circulation of high-risk patients. This study aimed to evaluate the hypothesis that placement of Proseal laryngeal mask airway (PLMA) and intubating laryngeal mask airway (ILMA) are associated with less cardiovascular response than the endotracheal intubation via conventional technique. Materials and Methods: In this hospital-based, randomized, interventional study, 105 patients of the American Society of Anesthesiologists Grade II and III undergoing coronary artery bypass grafting surgery under general anesthesia were randomly allocated into three groups, that is, PLMA, ILMA, and ETT. Hemodynamic parameters such as heart rate, blood pressure, cardiac output, cardiac index, systemic vascular resistance (SVR,) and SVR index baseline, during induction and after insertion of device were compared. Results: The study groups were comparable with respect to age, weight, height, gender, and baseline hemodynamic parameters. The heart rate, systolic blood pressure, diastolic blood pressure, and MAP were significantly higher (P < 0.05) in endotracheal group as compared to PLMA and ILMA groups for 15 min following intubation, that is, throughout the study period. However, there was no significant difference between PLMA and ILMA group (P > 0.05). SVR was significantly higher in endotracheal group as compared to PLMA and ILMA group throughout the study (P < 0.05). The cardiac index at all time was not significantly different among the three groups. Conclusion: PLMA and ILMA insertion is accompanied by minimal cardiovascular responses than those associated with direct laryngoscopic endotracheal intubation, so it can be used for patients in whom a marked pressor response would be deleterious.
{"title":"Comparative study of hemodynamic changes using proseal laryngeal mask airway, intubating laryngeal mask airway or laryngoscopic endotracheal intubation under general anesthesia in patients undergoing coronary artery bypass grafting surgery","authors":"Anjum Saiyed, Abhishek Jain, I. Verma, R. Meena","doi":"10.4103/KAJ.KAJ_16_18","DOIUrl":"https://doi.org/10.4103/KAJ.KAJ_16_18","url":null,"abstract":"Introduction: Laryngoscopy and endotracheal intubation alter cardiovascular physiology both via reflex responses and physical presence of an endotracheal tube (ETT). Stress response caused by laryngoscopic endotracheal intubation may be harmful for the coronary or cerebral circulation of high-risk patients. This study aimed to evaluate the hypothesis that placement of Proseal laryngeal mask airway (PLMA) and intubating laryngeal mask airway (ILMA) are associated with less cardiovascular response than the endotracheal intubation via conventional technique. Materials and Methods: In this hospital-based, randomized, interventional study, 105 patients of the American Society of Anesthesiologists Grade II and III undergoing coronary artery bypass grafting surgery under general anesthesia were randomly allocated into three groups, that is, PLMA, ILMA, and ETT. Hemodynamic parameters such as heart rate, blood pressure, cardiac output, cardiac index, systemic vascular resistance (SVR,) and SVR index baseline, during induction and after insertion of device were compared. Results: The study groups were comparable with respect to age, weight, height, gender, and baseline hemodynamic parameters. The heart rate, systolic blood pressure, diastolic blood pressure, and MAP were significantly higher (P < 0.05) in endotracheal group as compared to PLMA and ILMA groups for 15 min following intubation, that is, throughout the study period. However, there was no significant difference between PLMA and ILMA group (P > 0.05). SVR was significantly higher in endotracheal group as compared to PLMA and ILMA group throughout the study (P < 0.05). The cardiac index at all time was not significantly different among the three groups. Conclusion: PLMA and ILMA insertion is accompanied by minimal cardiovascular responses than those associated with direct laryngoscopic endotracheal intubation, so it can be used for patients in whom a marked pressor response would be deleterious.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84090640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hypertrophic obstructive cardiomyopathy (HOCM) is the most common inherited cardiovascular disease, which causes significant involvement of mitral valve in the pathogenesis of left ventricular outflow tract (LVOT) obstruction. A 37-year-old man, a diagnosed case of HOCM, reported to us with complaints of angina and difficulty in breathing. His preoperative echocardiography revealed a predominant LVOT obstruction which caused a resting gradient of 50 mmHg. It was associated with the presence of systolic anterior motion (SAM) and posteriorly directed moderately severe regurgitation jet. Plication of anterior mitral leaflet (AML) was done through transaortic approach while performing septal myectomy. Plicating AML through transaorta was tailored under transesophageal echocardiographic guidance where the height of AML was reduced by 1 cm. As a result, postoperative SAM was significantly reduced. The approach of plicating AML through transaorta became technically simpler with the help of transesophageal echocardiography.
{"title":"Anterior mitral leaflet repair in hypertrophic obstructive cardiomyopathy: A tailored approach under transesophageal echocardiographic guidance","authors":"Sucharita Das, S. Sridhar, P. Rao","doi":"10.4103/KAJ.KAJ_7_17","DOIUrl":"https://doi.org/10.4103/KAJ.KAJ_7_17","url":null,"abstract":"Hypertrophic obstructive cardiomyopathy (HOCM) is the most common inherited cardiovascular disease, which causes significant involvement of mitral valve in the pathogenesis of left ventricular outflow tract (LVOT) obstruction. A 37-year-old man, a diagnosed case of HOCM, reported to us with complaints of angina and difficulty in breathing. His preoperative echocardiography revealed a predominant LVOT obstruction which caused a resting gradient of 50 mmHg. It was associated with the presence of systolic anterior motion (SAM) and posteriorly directed moderately severe regurgitation jet. Plication of anterior mitral leaflet (AML) was done through transaortic approach while performing septal myectomy. Plicating AML through transaorta was tailored under transesophageal echocardiographic guidance where the height of AML was reduced by 1 cm. As a result, postoperative SAM was significantly reduced. The approach of plicating AML through transaorta became technically simpler with the help of transesophageal echocardiography.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87291903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Sundaram, Shibinath Veluthamanil, Abisha Sahaya Mercyline, A. Gilbert, Godwin Jino, S. Dhas
Hereby, we present the case of an adult with cleidocranial dysplasia who underwent multiple tooth extraction. In this article, characteristics of this genetic disorder and implications for an anesthesiologist are being discussed.
{"title":"Anesthetic management of a case of cleidocranial dysplasia","authors":"A. Sundaram, Shibinath Veluthamanil, Abisha Sahaya Mercyline, A. Gilbert, Godwin Jino, S. Dhas","doi":"10.4103/KAJ.KAJ_10_18","DOIUrl":"https://doi.org/10.4103/KAJ.KAJ_10_18","url":null,"abstract":"Hereby, we present the case of an adult with cleidocranial dysplasia who underwent multiple tooth extraction. In this article, characteristics of this genetic disorder and implications for an anesthesiologist are being discussed.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72981612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adrenocorticotrophic hormone-secreting pituitary adenoma is though quite rare yet carries significant mortality and morbidity due to severe comorbidities associated with them. Transsphenoidal resection of pituitary adenoma is the treatment of choice. While managing these patients, anesthesiologists face hosts of challenges since there are significant alterations in pathophysiology of the body. A thorough understanding of preoperative assessment, intraoperative management, and potential complications is fundamental for successful perioperative outcome. We report a case of Cushing's disease who underwent pituitary tumor resection and discuss the difficulties encountered and their management.
{"title":"A patient with Cushing's disease for pituitary tumor resection: Anesthetic challenges and management","authors":"R. Bala, G. Vashisht, I. Singh, S. Siddique","doi":"10.4103/KAJ.KAJ_6_18","DOIUrl":"https://doi.org/10.4103/KAJ.KAJ_6_18","url":null,"abstract":"Adrenocorticotrophic hormone-secreting pituitary adenoma is though quite rare yet carries significant mortality and morbidity due to severe comorbidities associated with them. Transsphenoidal resection of pituitary adenoma is the treatment of choice. While managing these patients, anesthesiologists face hosts of challenges since there are significant alterations in pathophysiology of the body. A thorough understanding of preoperative assessment, intraoperative management, and potential complications is fundamental for successful perioperative outcome. We report a case of Cushing's disease who underwent pituitary tumor resection and discuss the difficulties encountered and their management.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84394191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Sundaram, V. Balakrishnan, Anderson Abzalom, G. Aparna, D. Sivalingam
Pheochromocytomas are catecholamine secreting tumours that arise from the chromaffin cells located within the adrenal medulla. Paragangliomas are also catecholamine secreting tumours arising from extra-adrenal chromaffin cells located along the sympathetic paravertebral ganglia of the pelvis, abdomen, and thorax. The anaesthetic management of both Pheochromocytoma and paraganglioma are same. The anaesthetic care of patients with pheochromocytoma and paraganglioma (PPGL) presenting for surgical resection presents a challenge for the anaesthesiologist, but this challenge will be greatly increased when the tumour is unexpected.
{"title":"Anesthetic management of a patient with undiagnosed paraganglioma","authors":"A. Sundaram, V. Balakrishnan, Anderson Abzalom, G. Aparna, D. Sivalingam","doi":"10.4103/kaj.kaj_8_18","DOIUrl":"https://doi.org/10.4103/kaj.kaj_8_18","url":null,"abstract":"Pheochromocytomas are catecholamine secreting tumours that arise from the chromaffin cells located within the adrenal medulla. Paragangliomas are also catecholamine secreting tumours arising from extra-adrenal chromaffin cells located along the sympathetic paravertebral ganglia of the pelvis, abdomen, and thorax. The anaesthetic management of both Pheochromocytoma and paraganglioma are same. The anaesthetic care of patients with pheochromocytoma and paraganglioma (PPGL) presenting for surgical resection presents a challenge for the anaesthesiologist, but this challenge will be greatly increased when the tumour is unexpected.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89440560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: Neuromuscular blockers are drugs used to facilitate endotracheal intubation and to improve surgical working conditions during general anesthesia. Rocuronium with rapid onset of action acts synergistically with other nondepolarizing agents. The purpose of this study was, therefore, to compare onset time, clinical duration, intubating conditions, and hemodynamic changes with rocuronium, vecuronium, and a combination of rocuronium and vecuronium. Methodology: This prospective, randomized, double-blind, controlled comparative study included 150 American Society of Anesthesiologist Grade I or Grade II adult patients, scheduled for elective lower abdominal (gynecological and general surgical) and perineal surgery requiring general anesthesia with endotracheal intubation. The tracheal intubation conditions were evaluated on the first attempt and scored on a scale described by Clarke and Mirakhur (excellent, good, poor, and inadequate). In addition to routine cardiovascular monitoring, hemodynamic parameters were specifically noted before the administration of the intubating dose of study drug and 1, 2, 5, 10, and 15 min thereafter. Results: In rocuronium group and rocuronium and vecuronium combination groups, excellent and good intubation conditions were achieved in 78% and 22% of cases as compared to 42% and 58% in vecuronium group, respectively. Conclusion: The drug combination can provide a clinically comparable condition for tracheal intubation with near similar hemodynamic parameters as compared with rocuronium alone. This further points out toward the fact that the combination of rocuronium with vecuronium can be economical alternative for rapid intubation in elective surgical cases.
{"title":"Comparison of intubating conditions and hemodynamic effects of a combination of rocuronium and vecuronium with rocuronium or vecuronium used alone in patients undergoing elective lower abdominal and perineal surgery","authors":"Parameswar Kumar Rout, Ankur Sharma","doi":"10.4103/KAJ.KAJ_15_18","DOIUrl":"https://doi.org/10.4103/KAJ.KAJ_15_18","url":null,"abstract":"Aim: Neuromuscular blockers are drugs used to facilitate endotracheal intubation and to improve surgical working conditions during general anesthesia. Rocuronium with rapid onset of action acts synergistically with other nondepolarizing agents. The purpose of this study was, therefore, to compare onset time, clinical duration, intubating conditions, and hemodynamic changes with rocuronium, vecuronium, and a combination of rocuronium and vecuronium. Methodology: This prospective, randomized, double-blind, controlled comparative study included 150 American Society of Anesthesiologist Grade I or Grade II adult patients, scheduled for elective lower abdominal (gynecological and general surgical) and perineal surgery requiring general anesthesia with endotracheal intubation. The tracheal intubation conditions were evaluated on the first attempt and scored on a scale described by Clarke and Mirakhur (excellent, good, poor, and inadequate). In addition to routine cardiovascular monitoring, hemodynamic parameters were specifically noted before the administration of the intubating dose of study drug and 1, 2, 5, 10, and 15 min thereafter. Results: In rocuronium group and rocuronium and vecuronium combination groups, excellent and good intubation conditions were achieved in 78% and 22% of cases as compared to 42% and 58% in vecuronium group, respectively. Conclusion: The drug combination can provide a clinically comparable condition for tracheal intubation with near similar hemodynamic parameters as compared with rocuronium alone. This further points out toward the fact that the combination of rocuronium with vecuronium can be economical alternative for rapid intubation in elective surgical cases.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74729531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anesthesia for light amplification by stimulated emission of radiation dacryocystorhinostomy in a patient with automated implantable cardioverter defibrillator","authors":"S. Shalini, N. Jain","doi":"10.4103/kaj.kaj_5_18","DOIUrl":"https://doi.org/10.4103/kaj.kaj_5_18","url":null,"abstract":"","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82136398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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