Retrograde intubation is one of the techniques, which is useful for difficult airway management. Selecting the method of airway intervention in a difficult airway scenario depends on clinical judgment and experience of the attending anesthesiologist. Retrograde intubation stands as one of the better alternatives in the settings where fiberoptic bronchoscope is not available. We successfully managed a case of status post (s/p) subtotal maxillectomy and reconstruction left tensor fascia flap and s/p tracheostomy decannulated with raw wound over neck posted for right deltopectoral flap cover by awake retrograde intubation.
{"title":"Retrograde intubation in a patient status post subtotal maxillectomy with restricted mouth opening","authors":"C. Tatikonda, C. Tejesh, S. Archana","doi":"10.4103/kaj.kaj_1_18","DOIUrl":"https://doi.org/10.4103/kaj.kaj_1_18","url":null,"abstract":"Retrograde intubation is one of the techniques, which is useful for difficult airway management. Selecting the method of airway intervention in a difficult airway scenario depends on clinical judgment and experience of the attending anesthesiologist. Retrograde intubation stands as one of the better alternatives in the settings where fiberoptic bronchoscope is not available. We successfully managed a case of status post (s/p) subtotal maxillectomy and reconstruction left tensor fascia flap and s/p tracheostomy decannulated with raw wound over neck posted for right deltopectoral flap cover by awake retrograde intubation.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75571831","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 : 2017-01-01DOI: 10.4103/2394-6954.227080
Ravichandran Narayanan, S. Patil, Raghuvarathan
Lamellar ichthyosis constitutes a distinct group of inherited ichthyosis characterized by excessive scaling and dryness. Abnormalities in epidermal differentiation and metabolism contribute to excessive keratinization, which is a hallmark of this disorder. We present here the successful anesthetic management of a 13-year-old boy with lamellar ichthyosis for the correction of Genu Valgum deformity.
{"title":"Lamellar Ichthyosis; An Uncommon Acquaintance with Anesthesiologists: Overcoming Barriers","authors":"Ravichandran Narayanan, S. Patil, Raghuvarathan","doi":"10.4103/2394-6954.227080","DOIUrl":"https://doi.org/10.4103/2394-6954.227080","url":null,"abstract":"Lamellar ichthyosis constitutes a distinct group of inherited ichthyosis characterized by excessive scaling and dryness. Abnormalities in epidermal differentiation and metabolism contribute to excessive keratinization, which is a hallmark of this disorder. We present here the successful anesthetic management of a 13-year-old boy with lamellar ichthyosis for the correction of Genu Valgum deformity.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84528654","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 : 2017-01-01DOI: 10.4103/2394-6954.227082
Sudhir Gupta, P. Goyal
Background and Aims: Bispectral index response(BIS) reflects cerebral cortical activity and is an important pharmacodynamic parameter of anaesthetic effects on central nervous system. The prospective double blinded controlled study was undertaken to study effect of beta-1 antagonist esmolol on BIS, arm movement during intubation. Methods: Fifty adult patients aged 18 to 60 years scheduled for elective non-cardiac, non-cranial surgery surgery under general anaesthesia were undertaken for the study. Randomisation was done using closed envelope method. Data was analysed with Stat-View (Version 18, SPSS). Chi-square test was used to compare percentage of patients with arm movement. Results: Demographic variables age, weight, intubation duration, sex had P-value greater than 0.05. Arm movement was observed in 40% of patients in Esmolol group against 84% patients in Control group. T-value was below 0.05. Conclusion: Addition of esmolol leads to attenuation of haemodynamic, arm movements and BIS increase in response to intubation.
{"title":"To Study the Effect of Beta Antagonist Esmolol on Bispectral Index and Arm Movement During Intubation","authors":"Sudhir Gupta, P. Goyal","doi":"10.4103/2394-6954.227082","DOIUrl":"https://doi.org/10.4103/2394-6954.227082","url":null,"abstract":"Background and Aims: Bispectral index response(BIS) reflects cerebral cortical activity and is an important pharmacodynamic parameter of anaesthetic effects on central nervous system. The prospective double blinded controlled study was undertaken to study effect of beta-1 antagonist esmolol on BIS, arm movement during intubation. Methods: Fifty adult patients aged 18 to 60 years scheduled for elective non-cardiac, non-cranial surgery surgery under general anaesthesia were undertaken for the study. Randomisation was done using closed envelope method. Data was analysed with Stat-View (Version 18, SPSS). Chi-square test was used to compare percentage of patients with arm movement. Results: Demographic variables age, weight, intubation duration, sex had P-value greater than 0.05. Arm movement was observed in 40% of patients in Esmolol group against 84% patients in Control group. T-value was below 0.05. Conclusion: Addition of esmolol leads to attenuation of haemodynamic, arm movements and BIS increase in response to intubation.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80923219","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}
J. Ramteke, D. Sahu, A. Sharma, Renu Upadhyay, Gitika Pardhi
{"title":"Unusual Cause of Ventilator Malfunction: Misplacement of Nasogastric Tube","authors":"J. Ramteke, D. Sahu, A. Sharma, Renu Upadhyay, Gitika Pardhi","doi":"10.4103/kaj.kaj_28_17","DOIUrl":"https://doi.org/10.4103/kaj.kaj_28_17","url":null,"abstract":"","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82284477","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":"A Case of Suspected Unconsciousness in a Parturient: Does Psychiatric Disorder Come to the Mind of an Anesthesiologist?","authors":"Ramyavel Thangavelu","doi":"10.4103/kaj.kaj_3_18","DOIUrl":"https://doi.org/10.4103/kaj.kaj_3_18","url":null,"abstract":"","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72613297","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}
M. Salehi, K. Saberi, Mehrzad Rahmanian, R. Ali, Bakhshandeh, Shahnaz Sharifi, R. Sattarzadeh, A. Tavoosi
Early detection and management of pulmonary embolism would ameliorate survival chances. Here, we report the case of a patient who was scheduled for a renal carcinoma and inferior vena cava thrombectomy wherein suddenly the thrombus migrated to the pulmonary artery. The problem was rapidly recognized by transesophageal echocardiography and before a fatal hemodynamic instability cardiopulmonary bypass was instituted and the thrombosis was extracted. The patient was discharged a week after the surgery without any complication.
{"title":"Early Detection of Pulmonary Thromboemboli during Nephrectomy Using Transesophageal Echocardiography","authors":"M. Salehi, K. Saberi, Mehrzad Rahmanian, R. Ali, Bakhshandeh, Shahnaz Sharifi, R. Sattarzadeh, A. Tavoosi","doi":"10.4103/kaj.kaj_22_17","DOIUrl":"https://doi.org/10.4103/kaj.kaj_22_17","url":null,"abstract":"Early detection and management of pulmonary embolism would ameliorate survival chances. Here, we report the case of a patient who was scheduled for a renal carcinoma and inferior vena cava thrombectomy wherein suddenly the thrombus migrated to the pulmonary artery. The problem was rapidly recognized by transesophageal echocardiography and before a fatal hemodynamic instability cardiopulmonary bypass was instituted and the thrombosis was extracted. The patient was discharged a week after the surgery without any complication.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84577018","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}
S. Chouhan, Nabila Shaikh, Tasneem S Dhansura, Amit Sharma
Air embolism is well-known but uncommon and cerebral venous gas embolism (CVGE) is even more so because it goes unnoticed in an anaesthetized patient, especially where slow entrainment of small amounts of air takes place over a period of time. A young American Society of Anesthesiologists (ASA) status I patient underwent a lumbar spine surgery and presented in the post anaesthesia care unit (PACU) with seizures. Common causes of generalised tonic clonic seizures were ruled out and cerebral hypoperfusion as a result of retrograde CVGE was the retrospective diagnosis of exclusion. The patient developed retrograde CVGE in the absence of any intracardiac septal defect or patent foramen ovale. The prone positioning along with the anatomy of the valveless vertebral plexus of veins plays an important role in the development of retrograde CVGE. A high index of suspicion and awareness is warranted from anaesthesiologists so as not to delay diagnosis and treatment of this rare entity.
{"title":"Retrograde Cerebral Venous Gas Embolism: Could it be Possible?","authors":"S. Chouhan, Nabila Shaikh, Tasneem S Dhansura, Amit Sharma","doi":"10.4103/KAJ.KAJ_43_16","DOIUrl":"https://doi.org/10.4103/KAJ.KAJ_43_16","url":null,"abstract":"Air embolism is well-known but uncommon and cerebral venous gas embolism (CVGE) is even more so because it goes unnoticed in an anaesthetized patient, especially where slow entrainment of small amounts of air takes place over a period of time. A young American Society of Anesthesiologists (ASA) status I patient underwent a lumbar spine surgery and presented in the post anaesthesia care unit (PACU) with seizures. Common causes of generalised tonic clonic seizures were ruled out and cerebral hypoperfusion as a result of retrograde CVGE was the retrospective diagnosis of exclusion. The patient developed retrograde CVGE in the absence of any intracardiac septal defect or patent foramen ovale. The prone positioning along with the anatomy of the valveless vertebral plexus of veins plays an important role in the development of retrograde CVGE. A high index of suspicion and awareness is warranted from anaesthesiologists so as not to delay diagnosis and treatment of this rare entity.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73406346","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}
R. Dhanpal, Vikram M. Shivappagoudar, Gerard Gonsalvez, Reshma Vithayathil, Ann Mary Alappat
Anesthetic management of patients with mediastinal masses remains a formidable challenge as acute cardiorespiratory decompensation may follow induction of anesthesia. In endemic goiter areas, 20% of the population over the age of 70 will have a retrosternal goiter. This group of patients is heterogeneous with respect to the clinical evolution as well as with their various types, sizes, and location of masses. The vital organs in the limited mediastinal space may be affected in different ways. Therefore, the respiratory and hemodynamic responses to anesthesia may vary among individuals. There are sporadic case reports which illustrate acute cardiorespiratory decompensation during the course of anesthesia due to tumor-related compression of mediastinal organs, resulting in life-threatening conditions and even fatal outcomes. We describe the anesthetic management of a patient with multinodular goiter with retrosternal and mediastinal extension posted for total thyroidectomy, who was successfully managed with a double-lumen endotracheal tube.
{"title":"Anesthetic Management of a Patient with Retrosternal Goiter Using a Double-lumen Endotracheal Tube","authors":"R. Dhanpal, Vikram M. Shivappagoudar, Gerard Gonsalvez, Reshma Vithayathil, Ann Mary Alappat","doi":"10.4103/KAJ.KAJ_6_17","DOIUrl":"https://doi.org/10.4103/KAJ.KAJ_6_17","url":null,"abstract":"Anesthetic management of patients with mediastinal masses remains a formidable challenge as acute cardiorespiratory decompensation may follow induction of anesthesia. In endemic goiter areas, 20% of the population over the age of 70 will have a retrosternal goiter. This group of patients is heterogeneous with respect to the clinical evolution as well as with their various types, sizes, and location of masses. The vital organs in the limited mediastinal space may be affected in different ways. Therefore, the respiratory and hemodynamic responses to anesthesia may vary among individuals. There are sporadic case reports which illustrate acute cardiorespiratory decompensation during the course of anesthesia due to tumor-related compression of mediastinal organs, resulting in life-threatening conditions and even fatal outcomes. We describe the anesthetic management of a patient with multinodular goiter with retrosternal and mediastinal extension posted for total thyroidectomy, who was successfully managed with a double-lumen endotracheal tube.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84178363","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}
VP Shunt is one of the most commonly performed neurological surgeries.The patients undergoing this procedure may vary in age from neonates to elderly; they may be fully conscious or neurologically impaired. Knowledge of specific considerations of these patients will help the anesthesiologist to manage these patients in a better way.
{"title":"Anaesthesia for VP Shunt Surgery","authors":"S. Bloria, Pallavi Bloria, Ketan K Kataria","doi":"10.4103/KAJ.KAJ_17_17","DOIUrl":"https://doi.org/10.4103/KAJ.KAJ_17_17","url":null,"abstract":"VP Shunt is one of the most commonly performed neurological surgeries.The patients undergoing this procedure may vary in age from neonates to elderly; they may be fully conscious or neurologically impaired. Knowledge of specific considerations of these patients will help the anesthesiologist to manage these patients in a better way.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79472357","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}
Prevention of postdelivery intraoperative nausea and vomiting (IONV) is one of the concerns of anesthesiologist during surgery. The main aim is to keep the patient as comfortable as possible perioperatively. Various drugs, especially prokinetics and serotonin receptor antagonists, are frequently used to overcome IONV. Among them, ondansetron is most commonly used due to lack of drug interactions and good potency. Although rare, various side effects including cardiovascular system are found with this drug. We encountered a case of symptomatic sinus bradycardia with ventricular ectopic beats after rapid intravenous ondansetron in a 31-year-old pregnant lady posted for emergency lower segment cesarean section.
{"title":"Using Inj. Ondansetron in pregnant female during LSCS? Beware!","authors":"A. Shetti, Rachita G Mustilwar","doi":"10.4103/kaj.kaj_3_17","DOIUrl":"https://doi.org/10.4103/kaj.kaj_3_17","url":null,"abstract":"Prevention of postdelivery intraoperative nausea and vomiting (IONV) is one of the concerns of anesthesiologist during surgery. The main aim is to keep the patient as comfortable as possible perioperatively. Various drugs, especially prokinetics and serotonin receptor antagonists, are frequently used to overcome IONV. Among them, ondansetron is most commonly used due to lack of drug interactions and good potency. Although rare, various side effects including cardiovascular system are found with this drug. We encountered a case of symptomatic sinus bradycardia with ventricular ectopic beats after rapid intravenous ondansetron in a 31-year-old pregnant lady posted for emergency lower segment cesarean section.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82320780","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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