Pub Date : 2015-07-01DOI: 10.4103/2394-6954.173538
Jayashree C Patki
{"title":"Hydrothorax: An uncommon complication of central venous catheterization","authors":"Jayashree C Patki","doi":"10.4103/2394-6954.173538","DOIUrl":"https://doi.org/10.4103/2394-6954.173538","url":null,"abstract":"","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73556831","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}
Pub Date : 2015-07-01DOI: 10.4103/2394-6954.173535
Surbhi Gupta, R. Nayar, R. Rani, Usha Sastry, A. Kartha
Airway management can be challenging in patients with impacted oropharyngeal foreign bodies, especially those with the shafts of the foreign bodies protruding from the mouth. Difficulties may be encountered in airway assessment, mask ventilation, laryngoscopy, and intubation. This may be compounded by the potential for airway obstruction and injury to adjacent neurovascular structures. We report the case of a 20-year-old lady who came to the emergency department with a toothbrush impacted in the oropharynx with its handle protruding out of the mouth. The anesthetic management followed to successfully intubate the patient and retrieve the foreign body has been discussed.
{"title":"Impacted toothbrush in the oropharynx: An anesthetic challenge","authors":"Surbhi Gupta, R. Nayar, R. Rani, Usha Sastry, A. Kartha","doi":"10.4103/2394-6954.173535","DOIUrl":"https://doi.org/10.4103/2394-6954.173535","url":null,"abstract":"Airway management can be challenging in patients with impacted oropharyngeal foreign bodies, especially those with the shafts of the foreign bodies protruding from the mouth. Difficulties may be encountered in airway assessment, mask ventilation, laryngoscopy, and intubation. This may be compounded by the potential for airway obstruction and injury to adjacent neurovascular structures. We report the case of a 20-year-old lady who came to the emergency department with a toothbrush impacted in the oropharynx with its handle protruding out of the mouth. The anesthetic management followed to successfully intubate the patient and retrieve the foreign body has been discussed.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78620829","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}
Pub Date : 2015-07-01DOI: 10.4103/2394-6954.173528
Karthik Jain, Vasudeva Upadhyaya, S. Varghese
Thromboangiitis obliterans (TAO) is often misdiagnosed and hence, there is enormous suffering by patients. Surgical options are limited in the management. Most of the drugs used for medical management do not alleviate pain or help in the healing of ischemic ulcer. Chemical lumbar sympathectomy (CLS) can help patients by relieving pain and improving blood flow to the affected area. It is a therapeutic option performed under local anesthesia with relatively less morbidity. Although the drugs used can cause neuritis, sympathectomy is a better option. Proper diagnosis and accurate neurolytic block helps in relieving patient suffering. A 30-year-old chronic smoker diagnosed to have TAO of the right lower limb underwent CLS with alcohol. The patient had good pain relief.
{"title":"Chemical lumbar sympathectomy for lower limb rest pain associated with thromboangiitis obliterans","authors":"Karthik Jain, Vasudeva Upadhyaya, S. Varghese","doi":"10.4103/2394-6954.173528","DOIUrl":"https://doi.org/10.4103/2394-6954.173528","url":null,"abstract":"Thromboangiitis obliterans (TAO) is often misdiagnosed and hence, there is enormous suffering by patients. Surgical options are limited in the management. Most of the drugs used for medical management do not alleviate pain or help in the healing of ischemic ulcer. Chemical lumbar sympathectomy (CLS) can help patients by relieving pain and improving blood flow to the affected area. It is a therapeutic option performed under local anesthesia with relatively less morbidity. Although the drugs used can cause neuritis, sympathectomy is a better option. Proper diagnosis and accurate neurolytic block helps in relieving patient suffering. A 30-year-old chronic smoker diagnosed to have TAO of the right lower limb underwent CLS with alcohol. The patient had good pain relief.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79782852","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}
Pub Date : 2015-07-01DOI: 10.4103/2394-6954.173527
L. Sherif, R. Hegde, Mallikajaya Mariswami, Anjali Ollapally
Background and Aims: Postoperative nausea and vomiting (PONV) still present an important problem in anesthesia. In order to identify surgical patients who may benefit from prophylactic antiemetic medication, it is of interest to evaluate the risk factors for PONV using a simple scoring system. The simplified Apfel score includes four factors: female gender, nonsmoking status, postoperative use of opioids, and previous history of PONV or motion sickness. Each of these risk factors is supposed to elevate the incidence of PONV by about 20%. The aim of this study was to validate Apfel's clinical risk assessment score for identification of patients with high risk for PONV in our hospital. Materials and Methods: In a prospective study, 150 patients posted for various elective surgeries under general anesthesia with endotracheal intubation were analyzed and grouped into five groups, based on the Apfel risk scoring system. Each risk was given a score of 1, the total score being 4. PONV was monitored for 24 h and classified as grades 0, 1, and 2. Grades 1 and 2 were considered as PONV. The results obtained were analyzed for total incidence of PONV in each group of Apfel's scores and they were compared with the predicted incidence of PONV as per the documented Apfel's risk assessment. Collected data were analyzed by the Chi-square test, and the scoring system was assessed for sensitivity and specificity. Results: Of the 150 patients assessed, a total of 42% had PONV. Patients grouped under Apfel Score I had PONV incidence of 25.5%, the group with Score II had an incidence of 37.8%, the group with Score III had 64.6%, and the group with Score IV had 83.3%. This incidence of PONV corresponded to the predicted approximate values of 20% for Apfel Score I, 40% for Apfel II, 60% for Apfel III, and 80% for Apfel IV. Conclusions: The Apfel scoring system is simple and useful for identifying patients with high risk for PONV.
{"title":"Validation of the Apfel scoring system for identification of High-risk patients for PONV","authors":"L. Sherif, R. Hegde, Mallikajaya Mariswami, Anjali Ollapally","doi":"10.4103/2394-6954.173527","DOIUrl":"https://doi.org/10.4103/2394-6954.173527","url":null,"abstract":"Background and Aims: Postoperative nausea and vomiting (PONV) still present an important problem in anesthesia. In order to identify surgical patients who may benefit from prophylactic antiemetic medication, it is of interest to evaluate the risk factors for PONV using a simple scoring system. The simplified Apfel score includes four factors: female gender, nonsmoking status, postoperative use of opioids, and previous history of PONV or motion sickness. Each of these risk factors is supposed to elevate the incidence of PONV by about 20%. The aim of this study was to validate Apfel's clinical risk assessment score for identification of patients with high risk for PONV in our hospital. Materials and Methods: In a prospective study, 150 patients posted for various elective surgeries under general anesthesia with endotracheal intubation were analyzed and grouped into five groups, based on the Apfel risk scoring system. Each risk was given a score of 1, the total score being 4. PONV was monitored for 24 h and classified as grades 0, 1, and 2. Grades 1 and 2 were considered as PONV. The results obtained were analyzed for total incidence of PONV in each group of Apfel's scores and they were compared with the predicted incidence of PONV as per the documented Apfel's risk assessment. Collected data were analyzed by the Chi-square test, and the scoring system was assessed for sensitivity and specificity. Results: Of the 150 patients assessed, a total of 42% had PONV. Patients grouped under Apfel Score I had PONV incidence of 25.5%, the group with Score II had an incidence of 37.8%, the group with Score III had 64.6%, and the group with Score IV had 83.3%. This incidence of PONV corresponded to the predicted approximate values of 20% for Apfel Score I, 40% for Apfel II, 60% for Apfel III, and 80% for Apfel IV. Conclusions: The Apfel scoring system is simple and useful for identifying patients with high risk for PONV.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83225937","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}
Pub Date : 2015-07-01DOI: 10.4103/2394-6954.173536
Rakshith Prasad, Chakravarthy Joel, Varghese K. Zachariah
Context: Intravenous (IV) tramadol has been in use for the treatment of postanesthetic shivering. Aims: To assess the efficacy of addition of tramadol to bupivacaine in subarachnoid block to reduce the incidence of shivering. Settings and Design: The study was conducted as a single-blind study in a 350-bedded teaching hospital. Materials and Methods: One hundred parturients undergoing cesarean section were randomly divided into two groups of 50 each. Group T received 0.2 mL (10 mg) of tramadol with 2 mL of 0.5% bupivacaine. The presence of shivering was noted intraoperatively and postoperatively. Statistical Analysis Used: Student's t-test (two-tailed, independent) was applied for continuous variables and Chi-square/Fisher's exact test was applied for categorical variables between the two groups. Results: Shivering was noted in 66% of the patients in Group NS as against the 16% noted in Group T with a majority of the cases (88%) noted in the intraoperative period. The mean duration to the two-segment regression was 135 ± 26 min in Group T versus 104 ± 22 min in Group NS and duration to 1-grade motor block regression was 128 ± 21 min in Group T versus 103 ± 18 min in Group NS. The analgesic effect of the block lasted for a mean duration of 232 min in Group T and 176 min in Group NS while nausea and vomiting were increased in group T versus NS. Conclusions: Tramadol (10 mg), along with bupivacaine given intrathecally plays a significant role in reducing the incidence of anesthesia-induced shivering in parturients while prolonging both the sensory and motor components of the subarachnoid block.
{"title":"Effectiveness of addition of intrathecal tramadol with hyperbaric bupivacaine in prevention of shivering in parturients undergoing cesarean section under spinal anesthesia: A randomized Placebo-controlled study","authors":"Rakshith Prasad, Chakravarthy Joel, Varghese K. Zachariah","doi":"10.4103/2394-6954.173536","DOIUrl":"https://doi.org/10.4103/2394-6954.173536","url":null,"abstract":"Context: Intravenous (IV) tramadol has been in use for the treatment of postanesthetic shivering. Aims: To assess the efficacy of addition of tramadol to bupivacaine in subarachnoid block to reduce the incidence of shivering. Settings and Design: The study was conducted as a single-blind study in a 350-bedded teaching hospital. Materials and Methods: One hundred parturients undergoing cesarean section were randomly divided into two groups of 50 each. Group T received 0.2 mL (10 mg) of tramadol with 2 mL of 0.5% bupivacaine. The presence of shivering was noted intraoperatively and postoperatively. Statistical Analysis Used: Student's t-test (two-tailed, independent) was applied for continuous variables and Chi-square/Fisher's exact test was applied for categorical variables between the two groups. Results: Shivering was noted in 66% of the patients in Group NS as against the 16% noted in Group T with a majority of the cases (88%) noted in the intraoperative period. The mean duration to the two-segment regression was 135 ± 26 min in Group T versus 104 ± 22 min in Group NS and duration to 1-grade motor block regression was 128 ± 21 min in Group T versus 103 ± 18 min in Group NS. The analgesic effect of the block lasted for a mean duration of 232 min in Group T and 176 min in Group NS while nausea and vomiting were increased in group T versus NS. Conclusions: Tramadol (10 mg), along with bupivacaine given intrathecally plays a significant role in reducing the incidence of anesthesia-induced shivering in parturients while prolonging both the sensory and motor components of the subarachnoid block.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87212738","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}
Pub Date : 2015-07-01DOI: 10.4103/2394-6954.173532
B. Manjula, P. Nagaraja
Electroconvulsive therapy is a simple procedure, performed on highly diverse patient population with severe, drug resistant depression and other psychiatric disorders. Due to the occurrence of physical and psychological trauma caused to the conscious patient, has led to the concept of modified electroconvulsuve therapy. Ideal anaesthetic used for electroconvulsive therapy should have characteristics that include rapid induction, shorter duration of action, minimal side effects, rapid recovery and no interference with electroconvulsive therapy efficiency. The present study has compared propofol, which has been increasingly used recently with thiopentone, the drug most widely acceptable even today as anaesthetic agents for electroconvulsive therapy. This study was performed to assess the comparative effects of propofol and thiopentone sodium on recovery profile, hemodynamic stability and seizure duration during and after electroconvulsive therapy.
{"title":"Comparison of thiopentone sodium and propofol as anesthetic agents for modified electroconvulsive therapy","authors":"B. Manjula, P. Nagaraja","doi":"10.4103/2394-6954.173532","DOIUrl":"https://doi.org/10.4103/2394-6954.173532","url":null,"abstract":"Electroconvulsive therapy is a simple procedure, performed on highly diverse patient population with severe, drug resistant depression and other psychiatric disorders. Due to the occurrence of physical and psychological trauma caused to the conscious patient, has led to the concept of modified electroconvulsuve therapy. Ideal anaesthetic used for electroconvulsive therapy should have characteristics that include rapid induction, shorter duration of action, minimal side effects, rapid recovery and no interference with electroconvulsive therapy efficiency. The present study has compared propofol, which has been increasingly used recently with thiopentone, the drug most widely acceptable even today as anaesthetic agents for electroconvulsive therapy. This study was performed to assess the comparative effects of propofol and thiopentone sodium on recovery profile, hemodynamic stability and seizure duration during and after electroconvulsive therapy.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90927941","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}
Pub Date : 2015-04-01DOI: 10.4103/2394-6954.163088
M. Jain, K. Kilpadi
We present a perioperative case of spontaneous pneumothorax in a 50-year-old female patient. The case report describes the presentation and outlines the management. The patient presented with difficulty in breathing, desaturation, and restlessness immediately after extubation. Decreased chest movements, hyperresonant percussion note, and absent air entry on auscultation on one side of her chest was noted. The patient was hemodynamically stable. Then, 100% O 2 with closed circuit was continued while a portable X-ray of her chest was taken to confirm the diagnosis of pneumothorax. Intercostal drainage was done on the affected side immediately and the symptoms were relieved. The case report discusses a very rare perioperative complication and highlights the importance of clinical diagnosis and swiftness of intervention.
{"title":"Perioperative pneumothorax: A rare complication","authors":"M. Jain, K. Kilpadi","doi":"10.4103/2394-6954.163088","DOIUrl":"https://doi.org/10.4103/2394-6954.163088","url":null,"abstract":"We present a perioperative case of spontaneous pneumothorax in a 50-year-old female patient. The case report describes the presentation and outlines the management. The patient presented with difficulty in breathing, desaturation, and restlessness immediately after extubation. Decreased chest movements, hyperresonant percussion note, and absent air entry on auscultation on one side of her chest was noted. The patient was hemodynamically stable. Then, 100% O 2 with closed circuit was continued while a portable X-ray of her chest was taken to confirm the diagnosis of pneumothorax. Intercostal drainage was done on the affected side immediately and the symptoms were relieved. The case report discusses a very rare perioperative complication and highlights the importance of clinical diagnosis and swiftness of intervention.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86908634","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}
Pub Date : 2015-04-01DOI: 10.4103/2394-6954.163083
Nikhila Rajendra, Ravi Madhusudhana
Patients undergoing noncardiac surgery may develop cardiac complications. Perioperative myocardial infarction (PMI) may be an important predictor of short- and long-term morbidity and mortality associated with noncardiac surgery. The etiology of PMI can be multifactorial; hence, it is indicated that one single intervention will not successfully improve cardiac outcome following noncardiac surgery and multifactorial stepwise approach. Perioperative management of ischemic heart disease (IHD) patients undergoing noncardiac surgery requires careful teamwork and communication between the patient, primary care physician, anesthesiologist, and surgeon.
{"title":"Anesthetic management of a patient with ischemic heart disease posted for open reduction internal fixation of the upper limb","authors":"Nikhila Rajendra, Ravi Madhusudhana","doi":"10.4103/2394-6954.163083","DOIUrl":"https://doi.org/10.4103/2394-6954.163083","url":null,"abstract":"Patients undergoing noncardiac surgery may develop cardiac complications. Perioperative myocardial infarction (PMI) may be an important predictor of short- and long-term morbidity and mortality associated with noncardiac surgery. The etiology of PMI can be multifactorial; hence, it is indicated that one single intervention will not successfully improve cardiac outcome following noncardiac surgery and multifactorial stepwise approach. Perioperative management of ischemic heart disease (IHD) patients undergoing noncardiac surgery requires careful teamwork and communication between the patient, primary care physician, anesthesiologist, and surgeon.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88282850","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}
Pub Date : 2015-04-01DOI: 10.4103/2394-6954.163092
Madhavi Ravindra, D. Bhagya
Infantile hypertrophic pyloric stenosis (IHPS) is one of the most common gastrointestinal medical emergencies that occur during the first 2 months of life. Anaesthetic considerations in management of IHPS includes, aspiration prophylaxis and correction of metabolic derangements. An associated complex congenital cardiac lesion along with pulmonary hypertension and airway difficulties poses a further great challenge for the anaesthesiologist. We report a case of perioperative anesthetic management of a 2 month infant posted for open pyloromyotomy having complex congenital heart disease with pulmonary hypertension and bilateral cleft lip, the use of dobutamine in this setting is highlighted.
{"title":"Dobutamine infusion for complex congenital heart disease with pulmonary hypertension in an infant posted for open pyloromyotomy","authors":"Madhavi Ravindra, D. Bhagya","doi":"10.4103/2394-6954.163092","DOIUrl":"https://doi.org/10.4103/2394-6954.163092","url":null,"abstract":"Infantile hypertrophic pyloric stenosis (IHPS) is one of the most common gastrointestinal medical emergencies that occur during the first 2 months of life. Anaesthetic considerations in management of IHPS includes, aspiration prophylaxis and correction of metabolic derangements. An associated complex congenital cardiac lesion along with pulmonary hypertension and airway difficulties poses a further great challenge for the anaesthesiologist. We report a case of perioperative anesthetic management of a 2 month infant posted for open pyloromyotomy having complex congenital heart disease with pulmonary hypertension and bilateral cleft lip, the use of dobutamine in this setting is highlighted.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85010248","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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