Kavyashree, M. Shashank, A. Prabhu, Kiran Prasanan, B. Sumitha
Submental intubation is a very good alternative to tracheostomy when short term airway management is required with undisturbed access to oral or nasal airways. We report a case of basal cell carcinoma over the left nasolabial fold, involving the upper lip and alae of nose with coexisting coronary artery disease, old inferior wall myocardial infarction, and low ejection fraction managed successfully under general anesthesia with submental intubation.
{"title":"Submental intubation for wide excision of basal cell Carcinoma","authors":"Kavyashree, M. Shashank, A. Prabhu, Kiran Prasanan, B. Sumitha","doi":"10.4103/kaj.kaj_9_17","DOIUrl":"https://doi.org/10.4103/kaj.kaj_9_17","url":null,"abstract":"Submental intubation is a very good alternative to tracheostomy when short term airway management is required with undisturbed access to oral or nasal airways. We report a case of basal cell carcinoma over the left nasolabial fold, involving the upper lip and alae of nose with coexisting coronary artery disease, old inferior wall myocardial infarction, and low ejection fraction managed successfully under general anesthesia with submental intubation.","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":"80634547","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}
Background: Shivering is a frequent and distressing complication of spinal anaesthesia. Various drugs and physical methods are used to control shivering. Among pharmacological interventions, dexmedetomidine, a congener of clonidine, is a highly selective α2 adrenoreceptor agonist found to be effective in controlling shivering. The aim of this study is to evaluate the effect of the prophylactic administration of dexmedetomidine for prevention of shivering during spinal anaesthesia. Materials and Methods: A prospective, randomised and double-blind study was conducted among patients from either gender, aged 20–60 years, of American Society of Anesthesiologists (ASA) grade I or II who were scheduled for various surgeries under spinal anaesthesia. The patients were randomly divided into two groups of 60 each to receive either dexmedetomidine (Group D) 0.5 μg/kg or saline (Group S) immediately after spinal anaesthesia. Intraoperative incidence and grade of shivering, level of sedation, hemodynamic parameters and adverse reactions such as nausea and vomiting were recorded. Results: Seventeen patients in group S (28.3%) and 8 (13.3%) patients in group D experienced shivering (P = 0.043). Three patients in group S (3.3%) and 4 patients in group D (6.6%) had bradycardia (P = 0.69). Five patients in group S (8.3%) and 8 patients in group D (13.3%) had hypotension (P = 0.378). No patients in either group experienced nausea or vomiting. Conclusion: Prophylactic administration of dexmedetomidine significantly reduced shivering associated with spinal anaesthesia without any major adverse effect. Therefore, we conclude that dexmedetomidine infusion is an effective drug for preventing shivering and providing sedation in patients during spinal anaesthesia.
{"title":"Prophylactic administration of dexmedetomidine for prevention of shivering during spinal Anaesthesia","authors":"K. Prabhakaran, K. Raghu, N. Nikhil","doi":"10.4103/kaj.kaj_18_17","DOIUrl":"https://doi.org/10.4103/kaj.kaj_18_17","url":null,"abstract":"Background: Shivering is a frequent and distressing complication of spinal anaesthesia. Various drugs and physical methods are used to control shivering. Among pharmacological interventions, dexmedetomidine, a congener of clonidine, is a highly selective α2 adrenoreceptor agonist found to be effective in controlling shivering. The aim of this study is to evaluate the effect of the prophylactic administration of dexmedetomidine for prevention of shivering during spinal anaesthesia. Materials and Methods: A prospective, randomised and double-blind study was conducted among patients from either gender, aged 20–60 years, of American Society of Anesthesiologists (ASA) grade I or II who were scheduled for various surgeries under spinal anaesthesia. The patients were randomly divided into two groups of 60 each to receive either dexmedetomidine (Group D) 0.5 μg/kg or saline (Group S) immediately after spinal anaesthesia. Intraoperative incidence and grade of shivering, level of sedation, hemodynamic parameters and adverse reactions such as nausea and vomiting were recorded. Results: Seventeen patients in group S (28.3%) and 8 (13.3%) patients in group D experienced shivering (P = 0.043). Three patients in group S (3.3%) and 4 patients in group D (6.6%) had bradycardia (P = 0.69). Five patients in group S (8.3%) and 8 patients in group D (13.3%) had hypotension (P = 0.378). No patients in either group experienced nausea or vomiting. Conclusion: Prophylactic administration of dexmedetomidine significantly reduced shivering associated with spinal anaesthesia without any major adverse effect. Therefore, we conclude that dexmedetomidine infusion is an effective drug for preventing shivering and providing sedation in patients during spinal anaesthesia.","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":"77433479","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}
Background: Airway management is a core skill for an anaesthesiologist. However, the patterns of airway management practice vary among different practitioners, institutions, hospitals, and regions in India. In view of the limited literature in this regard, a survey was undertaken to assess different airway approach among anaesthesiologists of Karnataka. Materials and Methods: This was a prospective survey of 300 anaesthesiologists from Karnataka of varying backgrounds, from freelancers to academic departments. A prospective four-part questionnaire with 30 questions was sent to individual anaesthesiologists. Information was collected and data analyzed for demographic data, type, and preference of airway techniques and devices, availability of support, training, and complications. Results: i-gel was the most commonly used supraglottic airway device (SGAD) across age groups. There were significant differences in choice of drugs for insertion of SGAD among practitioners and academic consultants. For intubations, Vecuronium was preferred for adult patients, while Atracurium for children. The most common complication reported was desaturation and bradycardia (46%) in children. Conclusion: Survey shows differences in the practice patterns between academic and freelance setups in terms of device, technique, and drugs used. There appears to be a need to address the reasons for this difference.
{"title":"Survey of practice patterns of airway management: A comparison between academic and nonacademic setups in Karnataka","authors":"A. Somayaji, U. Raveendra","doi":"10.4103/kaj.kaj_16_17","DOIUrl":"https://doi.org/10.4103/kaj.kaj_16_17","url":null,"abstract":"Background: Airway management is a core skill for an anaesthesiologist. However, the patterns of airway management practice vary among different practitioners, institutions, hospitals, and regions in India. In view of the limited literature in this regard, a survey was undertaken to assess different airway approach among anaesthesiologists of Karnataka. Materials and Methods: This was a prospective survey of 300 anaesthesiologists from Karnataka of varying backgrounds, from freelancers to academic departments. A prospective four-part questionnaire with 30 questions was sent to individual anaesthesiologists. Information was collected and data analyzed for demographic data, type, and preference of airway techniques and devices, availability of support, training, and complications. Results: i-gel was the most commonly used supraglottic airway device (SGAD) across age groups. There were significant differences in choice of drugs for insertion of SGAD among practitioners and academic consultants. For intubations, Vecuronium was preferred for adult patients, while Atracurium for children. The most common complication reported was desaturation and bradycardia (46%) in children. Conclusion: Survey shows differences in the practice patterns between academic and freelance setups in terms of device, technique, and drugs used. There appears to be a need to address the reasons for this difference.","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":"77739274","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}
Central venous catheterization is usually carried out using modified Seldinger technique. Usually the mechanical complications such as looping and kinking are associated with the guide wire. We present a case of intravascular looping of a central venous catheter despite straightforward insertion and withdrawal of an intact undamaged guide wire.
{"title":"Intravascular looping of subclavian central venous catheter","authors":"H. Kapoor, H. Wagh","doi":"10.4103/kaj.kaj_46_16","DOIUrl":"https://doi.org/10.4103/kaj.kaj_46_16","url":null,"abstract":"Central venous catheterization is usually carried out using modified Seldinger technique. Usually the mechanical complications such as looping and kinking are associated with the guide wire. We present a case of intravascular looping of a central venous catheter despite straightforward insertion and withdrawal of an intact undamaged guide wire.","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":"81088092","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}
B. Shraddha, N. A. Anish Sharma, V. Niharika, M. Kavya, P. Shankaranarayana
Context: Opioids as adjuvants have been frequently used to prolong the neuraxial blockade for postoperative analgesia and are known to cause adverse effects. Nalbuphine, as an opioid with minimal adverse effects was tried for its effectiveness. Aims: Research was done to evaluate the effects of intrathecal Nalbuphine on the speed of onset of sensory and motor blockade, duration of analgesia and its side effects. Materials and Methods: Randomized clinical trial with a sample size of 60 adults in two groups of 30 each scheduled for lower abdominal and orthopaedic surgeries were included. Group 1 received 3 ml of hyperbaric bupivacaine 0.5% + 0.8 ml nalbuphine (0.8 mg) intrathecally, whereas group 2 received 3 ml of hyperbaric bupivacaine 0.5% + 0.8 ml of normal saline intrathecally. The onset of sensory and motor blockade, regression time of sensory blockade, duration of motor blockade, and analgesia, visual analogue scale (VAS) pain score and side effects were compared between the groups. Statistical Analysis Used: All the data was analyzed statistically and the significance was measured as probability of occurrence by the Student's t-test and Mann–Whitney U test. The values were expressed as mean ± the standard deviation and a P value less than 0.05 was considered statistically significant. Results: The onset of sensory blockade was slower with increased duration of analgesia. Regression time of sensory blockade and duration of effective analgesia was prolonged in the study group with no significant side effects. Conclusions: Improvement in the duration of sensory and motor blockade with minimal side effects was observed, thus proving that it is an effective intrathecal adjuvant for postoperative analgesia.
背景:阿片类药物作为佐剂经常被用于延长术后镇痛的神经轴阻滞，并且已知会引起不良反应。作为一种副作用最小的阿片类药物，纳布啡的有效性得到了验证。目的:评价鞘内注射纳布啡对感觉和运动阻滞发生速度、镇痛持续时间及副作用的影响。材料与方法:随机临床试验纳入60例成人，分为两组，每组30例，计划进行下腹部和骨科手术。组1鞘内给予布比卡因0.5%高压压3 ml +纳布啡0.8 ml (0.8 mg)，组2鞘内给予布比卡因0.5%高压压3 ml +生理盐水0.8 ml。比较两组感觉和运动阻断的发生时间、感觉阻断消退时间、运动阻断持续时间、镇痛情况、视觉模拟评分(VAS)疼痛评分及不良反应。统计学分析使用:对所有数据进行统计学分析，并采用Student's t检验和Mann-Whitney U检验以发生概率来衡量显著性。数值以均数±标准差表示，P值小于0.05认为有统计学意义。结果:随着镇痛时间的延长，感觉阻滞的发生变慢。实验组感觉阻滞消退时间延长，有效镇痛持续时间延长，无明显副作用。结论:观察到感觉和运动阻断持续时间的改善和最小的副作用，从而证明它是一种有效的鞘内辅助术后镇痛。
{"title":"Effects of intrathecal nalbuphine as an adjuvant for postoperative analgesia: A Randomized, double blind, control study","authors":"B. Shraddha, N. A. Anish Sharma, V. Niharika, M. Kavya, P. Shankaranarayana","doi":"10.4103/kaj.kaj_1_17","DOIUrl":"https://doi.org/10.4103/kaj.kaj_1_17","url":null,"abstract":"Context: Opioids as adjuvants have been frequently used to prolong the neuraxial blockade for postoperative analgesia and are known to cause adverse effects. Nalbuphine, as an opioid with minimal adverse effects was tried for its effectiveness. Aims: Research was done to evaluate the effects of intrathecal Nalbuphine on the speed of onset of sensory and motor blockade, duration of analgesia and its side effects. Materials and Methods: Randomized clinical trial with a sample size of 60 adults in two groups of 30 each scheduled for lower abdominal and orthopaedic surgeries were included. Group 1 received 3 ml of hyperbaric bupivacaine 0.5% + 0.8 ml nalbuphine (0.8 mg) intrathecally, whereas group 2 received 3 ml of hyperbaric bupivacaine 0.5% + 0.8 ml of normal saline intrathecally. The onset of sensory and motor blockade, regression time of sensory blockade, duration of motor blockade, and analgesia, visual analogue scale (VAS) pain score and side effects were compared between the groups. Statistical Analysis Used: All the data was analyzed statistically and the significance was measured as probability of occurrence by the Student's t-test and Mann–Whitney U test. The values were expressed as mean ± the standard deviation and a P value less than 0.05 was considered statistically significant. Results: The onset of sensory blockade was slower with increased duration of analgesia. Regression time of sensory blockade and duration of effective analgesia was prolonged in the study group with no significant side effects. Conclusions: Improvement in the duration of sensory and motor blockade with minimal side effects was observed, thus proving that it is an effective intrathecal adjuvant for postoperative analgesia.","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":"82029975","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}
Background: Repeated attempts at insertion, block failure, and post-dural puncture headache are the most common drawbacks of spinal anesthesia. This study was designed to re-evaluate these untoward effects of subarachnoid block. The primary aim of the study is to compare the incidence of post-dural puncture headache with 25-gauge Quincke's and Whitacre's spinal needles. The secondary objectives include assessing the difference in attempt rate and failure rate during subarachnoid block. Materials and Methods: In this randomized prospective study, 100 American Society of Anesthesiologists physical status I and II adult patients of both sex undergoing surgery below umbilicus under subarachnoid block were assigned in to two equal groups of 50 each; they were to receive spinal anesthesia either with Quincke's (group QC) or Whitacre's (group WP) spinal needles. The incidence of post-dural puncture headache, number of attempts required for successful insertion, and frequency of failed subarachnoid block were recorded. Data obtained were analyzed using t-test and Chi-square test. A value of P < 0.05 was deemed as statistically significant. Results: All the 100 patients completed the study. Significantly high rate (P = 0.009) of post-dural puncture headache was recorded in Quincke group (18%) as compared to Whitacre group (2%). In addition, the number of attempts required were less with Whitacre's needle; however, no statically significant association between the type of the needle, attempt rate, and failure rate during spinal anesthesia could be detected (P = 0.2425). Conclusion: Overall to reduce the number of attempts and the incidence of post-dural puncture headache, Whitacre's 25-gauge spinal needle has better option than Quincke's 25-gauge spinal needle for subarachnoid block.
{"title":"Incidence of post-dural puncture headache: A comparison of quinckes' versus whitacres' spinal needles","authors":"J. Irkal, S. Reddy, Diddi Krishn, A. Bhardwaj","doi":"10.4103/kaj.kaj_2_17","DOIUrl":"https://doi.org/10.4103/kaj.kaj_2_17","url":null,"abstract":"Background: Repeated attempts at insertion, block failure, and post-dural puncture headache are the most common drawbacks of spinal anesthesia. This study was designed to re-evaluate these untoward effects of subarachnoid block. The primary aim of the study is to compare the incidence of post-dural puncture headache with 25-gauge Quincke's and Whitacre's spinal needles. The secondary objectives include assessing the difference in attempt rate and failure rate during subarachnoid block. Materials and Methods: In this randomized prospective study, 100 American Society of Anesthesiologists physical status I and II adult patients of both sex undergoing surgery below umbilicus under subarachnoid block were assigned in to two equal groups of 50 each; they were to receive spinal anesthesia either with Quincke's (group QC) or Whitacre's (group WP) spinal needles. The incidence of post-dural puncture headache, number of attempts required for successful insertion, and frequency of failed subarachnoid block were recorded. Data obtained were analyzed using t-test and Chi-square test. A value of P < 0.05 was deemed as statistically significant. Results: All the 100 patients completed the study. Significantly high rate (P = 0.009) of post-dural puncture headache was recorded in Quincke group (18%) as compared to Whitacre group (2%). In addition, the number of attempts required were less with Whitacre's needle; however, no statically significant association between the type of the needle, attempt rate, and failure rate during spinal anesthesia could be detected (P = 0.2425). Conclusion: Overall to reduce the number of attempts and the incidence of post-dural puncture headache, Whitacre's 25-gauge spinal needle has better option than Quincke's 25-gauge spinal needle for subarachnoid block.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74179043","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}
Background: Functional endoscopic sinus surgery (FESS) is a widely performed operation with one of its major drawbacks being impaired visibility due to excessive bleeding. Controlled hypotension during general anaesthesia for FESS has been shown to improve surgical dissection. This study was carried out with the aim of evaluating the effect of dexmedetomidine on surgical blood loss and quality of surgical field in FESS. Methodology: This prospective randomized double blinded controlled study was conducted on 100 patients posted for elective FESS. After obtaining institutional ethical clearance, patients between the ages 18 and 60 yrs belonging to ASA PS I and II, scheduled to undergo elective FESS surgery under general anaesthesia were included in the study. Fifty patients each were sorted into either the study group (Group I/D) receiving dexmedetomidine or control group (Group II/NS) receiving normal saline. The two groups were compared using student's t-test for age, weight, mean arterial pressure, heart rate, amount of blood loss, EtCO2 and SpO2.Chi square analysis and Fisher's exact test were used for analysis of gender, ASA physical status and surgeon's satisfaction after surgery. Statistical significance was determined at P < 0.05. Results: Both the groups; D and NS were comparable in terms of weight, age, sex and ASA physical status. Mean arterial pressure (MAP) and heart rate (HR) were compared between the two groups at every step of the procedure and dexmedetomidine was shown to produce a drop in both hemodynamic parameters producing stable vital parameters. The average intraoperative blood loss was found to be significantly higher in the control group. Surgeon's satisfaction with the operative experience was also found to be significantly better with the study group than in the control group. Conclusion: This study found that dexmedetomidine produces stable blood pressure and heart rate with minimal fluctuations from the baseline during FESS. This hemodynamic stability leads not only to a good patient outcome, but also increases surgeon satisfaction.
{"title":"Effect of dexmedetomidine on blood loss and quality of surgical field in functional endoscopic sinus surgery: A double blinded prospective controlled study","authors":"A. Somayaji, U. Raveendra","doi":"10.4103/kaj.kaj_14_17","DOIUrl":"https://doi.org/10.4103/kaj.kaj_14_17","url":null,"abstract":"Background: Functional endoscopic sinus surgery (FESS) is a widely performed operation with one of its major drawbacks being impaired visibility due to excessive bleeding. Controlled hypotension during general anaesthesia for FESS has been shown to improve surgical dissection. This study was carried out with the aim of evaluating the effect of dexmedetomidine on surgical blood loss and quality of surgical field in FESS. Methodology: This prospective randomized double blinded controlled study was conducted on 100 patients posted for elective FESS. After obtaining institutional ethical clearance, patients between the ages 18 and 60 yrs belonging to ASA PS I and II, scheduled to undergo elective FESS surgery under general anaesthesia were included in the study. Fifty patients each were sorted into either the study group (Group I/D) receiving dexmedetomidine or control group (Group II/NS) receiving normal saline. The two groups were compared using student's t-test for age, weight, mean arterial pressure, heart rate, amount of blood loss, EtCO2 and SpO2.Chi square analysis and Fisher's exact test were used for analysis of gender, ASA physical status and surgeon's satisfaction after surgery. Statistical significance was determined at P < 0.05. Results: Both the groups; D and NS were comparable in terms of weight, age, sex and ASA physical status. Mean arterial pressure (MAP) and heart rate (HR) were compared between the two groups at every step of the procedure and dexmedetomidine was shown to produce a drop in both hemodynamic parameters producing stable vital parameters. The average intraoperative blood loss was found to be significantly higher in the control group. Surgeon's satisfaction with the operative experience was also found to be significantly better with the study group than in the control group. Conclusion: This study found that dexmedetomidine produces stable blood pressure and heart rate with minimal fluctuations from the baseline during FESS. This hemodynamic stability leads not only to a good patient outcome, but also increases surgeon satisfaction.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89447059","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}
V. Bhatnagar, D. Dwivedi, K. Jinjil, Shatabdi Chakraborty
Antiplatelet therapy plays an important role in the management of coronary artery disease (CAD) patients, which include the spectrum of patients with stents in situ and those suffering from acute coronary syndrome (ACS) on medical management. The percentage of patients with stents in situ, scheduled for surgery within 2 years, is approximately 5–15%. The antiplatelet therapy predisposes patients to an increased risk of bleeding in the perioperative region, which can lead to fatal outcomes in spinal or intracranial surgeries; the problem multiplies manifolds if the surgery has to be performed in an emergency situation. We report a case of a 76-year-old lady, a known case of CAD with drug eluting stent in situ, on dual antiplatelet agents who had presented to our hospital with progressive weakness of lower limbs and had to be operated on the spine in emergency situation.
{"title":"Anaesthetic management of emergency spine surgery with patient on dual antiplatelet agents","authors":"V. Bhatnagar, D. Dwivedi, K. Jinjil, Shatabdi Chakraborty","doi":"10.4103/kaj.kaj_44_16","DOIUrl":"https://doi.org/10.4103/kaj.kaj_44_16","url":null,"abstract":"Antiplatelet therapy plays an important role in the management of coronary artery disease (CAD) patients, which include the spectrum of patients with stents in situ and those suffering from acute coronary syndrome (ACS) on medical management. The percentage of patients with stents in situ, scheduled for surgery within 2 years, is approximately 5–15%. The antiplatelet therapy predisposes patients to an increased risk of bleeding in the perioperative region, which can lead to fatal outcomes in spinal or intracranial surgeries; the problem multiplies manifolds if the surgery has to be performed in an emergency situation. We report a case of a 76-year-old lady, a known case of CAD with drug eluting stent in situ, on dual antiplatelet agents who had presented to our hospital with progressive weakness of lower limbs and had to be operated on the spine in emergency situation.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86780730","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}
Difficult airway may be defined as a situation in which conventionally trained anesthetist has a difficulty in either mask ventilation, or endotracheal intubation, or both. Several management tools are available of difficult airway and one such tool is a videolaryngoscope. We are presenting a case report demonstrating the use of McGrath MAC videolaryngoscope in a patient with long standing neck swelling and restricted neck extension.
{"title":"Airway management using McGrath MAC videolaryngoscope in a patient with predicted difficult airway","authors":"N. Rekha","doi":"10.4103/kaj.kaj_45_16","DOIUrl":"https://doi.org/10.4103/kaj.kaj_45_16","url":null,"abstract":"Difficult airway may be defined as a situation in which conventionally trained anesthetist has a difficulty in either mask ventilation, or endotracheal intubation, or both. Several management tools are available of difficult airway and one such tool is a videolaryngoscope. We are presenting a case report demonstrating the use of McGrath MAC videolaryngoscope in a patient with long standing neck swelling and restricted neck extension.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82365354","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}
Context: Postoperative pain for inguinal hernia repair has been traditionally managed with infiltration of the wound with a local anesthetic. However, ultrasound-guided transversus abdominis plane (TAP) block has recently been used with precision to achieve effective control of postoperative pain. Aims: To evaluate the efficacy of ultrasound-guided TAP block for postoperative analgesia in patients undergoing inguinal hernia repair. Settings and Design: This was institutional-based randomized prospective clinical study. Materials and Methods: Adult patients were randomly allocated into those who received TAP block with bupivacaine (group T) and control group C was managed with rescue analgesia. Postoperative visual analogue score, time to first rescue analgesia, visual analogue score at first rescue dose, and total rescue doses consumed were assessed for both the groups. Statistical Analysis Used: Independent t-test, Fisher's exact test, and Chi-square test were used to analysis the data. P <0.05 was considered statistically significant. Results: There was no statistical difference for the demographic profile among the groups. On comparing the two groups, time to first rescue analgesia dose was longer in group T compared to group C (P = 0.01). Postoperative VAS scores and total rescue analgesia consumption was lower for the T group compared to group C up to 12 hours. Conclusions: TAP block is an effective tool in postoperative pain control. It is safe and easy to accomplish this block with the real-time ultrasonography.
{"title":"Ultrasound-guided transversus abdominis plane block for post-operative analgesia in inguinal hernia repair","authors":"D. Sharma, V. Singh, Alokik Mahajan","doi":"10.4103/kaj.kaj_34_16","DOIUrl":"https://doi.org/10.4103/kaj.kaj_34_16","url":null,"abstract":"Context: Postoperative pain for inguinal hernia repair has been traditionally managed with infiltration of the wound with a local anesthetic. However, ultrasound-guided transversus abdominis plane (TAP) block has recently been used with precision to achieve effective control of postoperative pain. Aims: To evaluate the efficacy of ultrasound-guided TAP block for postoperative analgesia in patients undergoing inguinal hernia repair. Settings and Design: This was institutional-based randomized prospective clinical study. Materials and Methods: Adult patients were randomly allocated into those who received TAP block with bupivacaine (group T) and control group C was managed with rescue analgesia. Postoperative visual analogue score, time to first rescue analgesia, visual analogue score at first rescue dose, and total rescue doses consumed were assessed for both the groups. Statistical Analysis Used: Independent t-test, Fisher's exact test, and Chi-square test were used to analysis the data. P <0.05 was considered statistically significant. Results: There was no statistical difference for the demographic profile among the groups. On comparing the two groups, time to first rescue analgesia dose was longer in group T compared to group C (P = 0.01). Postoperative VAS scores and total rescue analgesia consumption was lower for the T group compared to group C up to 12 hours. Conclusions: TAP block is an effective tool in postoperative pain control. It is safe and easy to accomplish this block with the real-time ultrasonography.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89060452","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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