Pub Date : 2016-01-01DOI: 10.4103/2394-6954.190777
T. Anandaswamy, Prathima P. Thamanna, G. Rajappa, M. Chikkapillappa
{"title":"Incidental detection of venous air embolism during modified radical neck dissection","authors":"T. Anandaswamy, Prathima P. Thamanna, G. Rajappa, M. Chikkapillappa","doi":"10.4103/2394-6954.190777","DOIUrl":"https://doi.org/10.4103/2394-6954.190777","url":null,"abstract":"","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80788979","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 : 2015-10-01DOI: 10.4103/2394-6954.180657
J. Attri, R. Khetarpal, Rajinder P Singh, Lipsy Bansal
Hysterical paralysis is an uncommon, psychogenic, nonorganic loss of motor function precipitated by some type of traumatic event. Typically, it is a diagnosis of exclusion after all the organic causes have been ruled out. The purpose of this case report is to highlight the phenomenon of hysterical paralysis.
{"title":"Hysterical paraplegia","authors":"J. Attri, R. Khetarpal, Rajinder P Singh, Lipsy Bansal","doi":"10.4103/2394-6954.180657","DOIUrl":"https://doi.org/10.4103/2394-6954.180657","url":null,"abstract":"Hysterical paralysis is an uncommon, psychogenic, nonorganic loss of motor function precipitated by some type of traumatic event. Typically, it is a diagnosis of exclusion after all the organic causes have been ruled out. The purpose of this case report is to highlight the phenomenon of hysterical paralysis.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82623735","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 : 2015-10-01DOI: 10.4103/2394-6954.180649
R. Garg, C. Dua
Background: Unexpected difficult intubation is probably the result of inadequate preoperative examination of airway and a lack of accurate predictive tests for difficult intubation. Preoperative evaluation forms basis to suspect and be prepared for a difficult airway situation. Aim: The aim of our study was to identify the ideal preoperative predictors of difficult intubation. Materials and Methods: It was a Prospective Observational study done on 350 patients in a community-based hospital. Preoperative airway assessment included: Mallampati Class (MC), Mouth opening (MO), Thyromental distance (TMD), Ability to prognath (AP) and Neck mobility and size (NM). Monitors were attached, anesthesia induced and laryngoscopy performed. Intubation Difficulty Scale (IDS) score was used to grade difficulty in intubation. Results: The overall incidence of Difficult Intubation was 24.6 %. A slight difficulty in 24% (IDS = 1-5) and moderate to major difficulty (IDS >5) in 0.6% cases was noted. Intubation was possible in all the patients. Mallampati class III & Mouth opening was less than 4 cm in about 6% cases and Thyromental distance less than 6 cm in 5.4%. 12.5% were unable to prognath and Neck mobility was restricted in 4.6% patients. Sensitivity and specificity of MC- 16.3 % and 97%, MO- 16.3% and 96.6%, TMD - 12.8% and 97%, AP - 33.3% and 93.9% , NM - 10.5% and 97.3%. Positive and Negative Predictive Values for MC, MO, TMD, AP and NM were 63.6% and 78%, 60.9% and 78%, 57.9 and 77.3 %, 62.8% and 81.9%, 56.3% and 76.9% respectively. Conclusion: We concluded that Mallampati grading and ability to prognath are the most important of the variables studied.
{"title":"Identification of ideal preoperative predictors for difficult intubation","authors":"R. Garg, C. Dua","doi":"10.4103/2394-6954.180649","DOIUrl":"https://doi.org/10.4103/2394-6954.180649","url":null,"abstract":"Background: Unexpected difficult intubation is probably the result of inadequate preoperative examination of airway and a lack of accurate predictive tests for difficult intubation. Preoperative evaluation forms basis to suspect and be prepared for a difficult airway situation. Aim: The aim of our study was to identify the ideal preoperative predictors of difficult intubation. Materials and Methods: It was a Prospective Observational study done on 350 patients in a community-based hospital. Preoperative airway assessment included: Mallampati Class (MC), Mouth opening (MO), Thyromental distance (TMD), Ability to prognath (AP) and Neck mobility and size (NM). Monitors were attached, anesthesia induced and laryngoscopy performed. Intubation Difficulty Scale (IDS) score was used to grade difficulty in intubation. Results: The overall incidence of Difficult Intubation was 24.6 %. A slight difficulty in 24% (IDS = 1-5) and moderate to major difficulty (IDS >5) in 0.6% cases was noted. Intubation was possible in all the patients. Mallampati class III & Mouth opening was less than 4 cm in about 6% cases and Thyromental distance less than 6 cm in 5.4%. 12.5% were unable to prognath and Neck mobility was restricted in 4.6% patients. Sensitivity and specificity of MC- 16.3 % and 97%, MO- 16.3% and 96.6%, TMD - 12.8% and 97%, AP - 33.3% and 93.9% , NM - 10.5% and 97.3%. Positive and Negative Predictive Values for MC, MO, TMD, AP and NM were 63.6% and 78%, 60.9% and 78%, 57.9 and 77.3 %, 62.8% and 81.9%, 56.3% and 76.9% respectively. Conclusion: We concluded that Mallampati grading and ability to prognath are the most important of the variables studied.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78593936","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 : 2015-10-01DOI: 10.4103/2394-6954.180650
V. Bhatnagar, D. Dwivedi, U. Tandon, K. Bhushan
Craniopharyngiomas constitute about 2–6% of all the intracranial tumors in the pediatric age group. Management of craniopharyngiomas in children is challenging for not only surgeons and endocrinologists but for anesthesiologists as well, owing to the developing neurological and physiological status, handling of a growing brain, perioperative endocrinological complications, and the management of hydration. We report a case of a 4-year-old child who had presented to our hospital with progressive loss of vision over a period of 2 months.
{"title":"The challenges in anesthetic management of pediatric craniopharyngioma","authors":"V. Bhatnagar, D. Dwivedi, U. Tandon, K. Bhushan","doi":"10.4103/2394-6954.180650","DOIUrl":"https://doi.org/10.4103/2394-6954.180650","url":null,"abstract":"Craniopharyngiomas constitute about 2–6% of all the intracranial tumors in the pediatric age group. Management of craniopharyngiomas in children is challenging for not only surgeons and endocrinologists but for anesthesiologists as well, owing to the developing neurological and physiological status, handling of a growing brain, perioperative endocrinological complications, and the management of hydration. We report a case of a 4-year-old child who had presented to our hospital with progressive loss of vision over a period of 2 months.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86971638","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 : 2015-10-01DOI: 10.4103/2394-6954.180656
I. Kapoor, C. Mahajan, H. Prabhakar
{"title":"An unintended cannulation of aberrant radial artery!","authors":"I. Kapoor, C. Mahajan, H. Prabhakar","doi":"10.4103/2394-6954.180656","DOIUrl":"https://doi.org/10.4103/2394-6954.180656","url":null,"abstract":"","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76429422","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 : 2015-10-01DOI: 10.4103/2394-6954.180661
R. Abhishek, Anish N. G. Sharma, P. Ganapathi, P. Shankaranarayana, D. Aiyappa, M. Nazim
Background: Preoperative preparation of children to alleviate the stress and anxiety related to surgery is an important aspect of balanced anesthesia care, it can not only affect the smoothness of induction and emergence from anesthesia but also the emotional and psychological make-up of the child, considering the pharmacological profile, midazolam is widely considered to be the ideal premedicant. The purpose of our prospective randomized observer-blinded study is to compare the effect of midazolam through oral and intranasal routes and determine the safer, more effective, and acceptable route by children. Subjects and Methods: Sixty patients aged 2–8 years, belonging to the American Society of Anesthesiologist I and II undergoing various surgeries were randomized into two groups of 30 each. Group O received 0.5 mg/kg of oral midazolam syrup, and Group N received 0.2 mg/kg of midazolam intranasal spray. Hemodynamic variables, sedation scores, ease of parental separation, and mask acceptance at the time of induction were studied. Results: Onset of sedation was shorter and the sedation scores were higher in intranasal group, separation from parents and acceptance to mask were satisfactory but statistically insignificant in both the groups. There was no statistical difference in hemodynamic parameters, and no major adverse effects were seen in either group. Conclusion: Both oral and intranasal midazolam are safe and effective as sedative premedication in children.
{"title":"A comparative study of intranasal midazolam spray and oral midazolam syrup as premedication in pediatric patients","authors":"R. Abhishek, Anish N. G. Sharma, P. Ganapathi, P. Shankaranarayana, D. Aiyappa, M. Nazim","doi":"10.4103/2394-6954.180661","DOIUrl":"https://doi.org/10.4103/2394-6954.180661","url":null,"abstract":"Background: Preoperative preparation of children to alleviate the stress and anxiety related to surgery is an important aspect of balanced anesthesia care, it can not only affect the smoothness of induction and emergence from anesthesia but also the emotional and psychological make-up of the child, considering the pharmacological profile, midazolam is widely considered to be the ideal premedicant. The purpose of our prospective randomized observer-blinded study is to compare the effect of midazolam through oral and intranasal routes and determine the safer, more effective, and acceptable route by children. Subjects and Methods: Sixty patients aged 2–8 years, belonging to the American Society of Anesthesiologist I and II undergoing various surgeries were randomized into two groups of 30 each. Group O received 0.5 mg/kg of oral midazolam syrup, and Group N received 0.2 mg/kg of midazolam intranasal spray. Hemodynamic variables, sedation scores, ease of parental separation, and mask acceptance at the time of induction were studied. Results: Onset of sedation was shorter and the sedation scores were higher in intranasal group, separation from parents and acceptance to mask were satisfactory but statistically insignificant in both the groups. There was no statistical difference in hemodynamic parameters, and no major adverse effects were seen in either group. Conclusion: Both oral and intranasal midazolam are safe and effective as sedative premedication in children.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76249008","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 : 2015-10-01DOI: 10.4103/2394-6954.180651
A. Kulkarni, S. Kulkarni, A. Tarkase
Huntington's chorea is a hereditary disorder characterized by continuous involuntary movements. Symptoms usually occur between the ages of 30 and 45 years and include choreatic movements, progressive mental deterioration, and ataxia. Various anesthetic techniques have been tried in these patients, both regional as well as general anesthesia. These patients are of special concern to anesthesiologists with respect to preoperative assessment and securing intravenous access due to their continuous movements. Such patients have to be managed with respect to providing airway protection and ensuring rapid and safe recovery. We report a case of Huntington's chorea who was anesthetized successfully for removal of foreign body cricopharynx without any deleterious postoperative outcome.
{"title":"Anesthesia in a patient with huntington's Chorea","authors":"A. Kulkarni, S. Kulkarni, A. Tarkase","doi":"10.4103/2394-6954.180651","DOIUrl":"https://doi.org/10.4103/2394-6954.180651","url":null,"abstract":"Huntington's chorea is a hereditary disorder characterized by continuous involuntary movements. Symptoms usually occur between the ages of 30 and 45 years and include choreatic movements, progressive mental deterioration, and ataxia. Various anesthetic techniques have been tried in these patients, both regional as well as general anesthesia. These patients are of special concern to anesthesiologists with respect to preoperative assessment and securing intravenous access due to their continuous movements. Such patients have to be managed with respect to providing airway protection and ensuring rapid and safe recovery. We report a case of Huntington's chorea who was anesthetized successfully for removal of foreign body cricopharynx without any deleterious postoperative outcome.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78215799","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 : 2015-10-01DOI: 10.4103/2394-6954.180653
Rajender Kumar, R. Gandhi, Meenaxi Bose
The spectrum of electrical injury ranges from minor skin lesions to severe multiorgan damage, at times associated with occult or delayed complications and even death. High-voltage electrical injury is characterized by skin lesions that are confined in comparison to the profound destruction of deeper tissues involved and masked by the good general condition of the patient. In light of the limited existing literature, we share our experience of managing a patient who survived a high-voltage electrical injury (6000 V) 5 days prior to scheduled laparoscopic interval appendicectomy, and discuss the factors that influence the degree of injury, probable complications, and our perioperative management.
{"title":"Perioperative management of a case for elective surgery after high-voltage electrical injury","authors":"Rajender Kumar, R. Gandhi, Meenaxi Bose","doi":"10.4103/2394-6954.180653","DOIUrl":"https://doi.org/10.4103/2394-6954.180653","url":null,"abstract":"The spectrum of electrical injury ranges from minor skin lesions to severe multiorgan damage, at times associated with occult or delayed complications and even death. High-voltage electrical injury is characterized by skin lesions that are confined in comparison to the profound destruction of deeper tissues involved and masked by the good general condition of the patient. In light of the limited existing literature, we share our experience of managing a patient who survived a high-voltage electrical injury (6000 V) 5 days prior to scheduled laparoscopic interval appendicectomy, and discuss the factors that influence the degree of injury, probable complications, and our perioperative management.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89023636","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 : 2015-10-01DOI: 10.4103/2394-6954.180655
S. Govindswamy, S. Geetha
Elderly patients with serious cardiac problems are presenting for major orthopedic surgeries. We present a case of an elderly male patient posted for total hip replacement having a permanent pacemaker in situ in ventricle paced, ventricle sensed, pacing inhibited (VVI) mode. The patient, on preoperative examination, was found to have a complete atrioventricular (AV) block on electrocardiogram (ECG) and electrophysiology study showed degenerative AV conduction disease and symptomatic complete AV block. The patient had seizure disorder and anemia, for which the patient was treated accordingly and optimized before surgery. The pacemaker mode changed to vesiculo-vacuolar organelle (VVO). Combined spinal-epidural was given. Arterial line was secured and the patient was monitored hemodynamically. The patient tolerated the procedure of total hip replacement well; vitals were maintained within 20% of the baseline. Phenylephrine infusion was given to maintain blood pressure. After operation was shifted to the intensive care unit (ICU), pacemaker was reprogrammed to VVI mode, and epidural infusion for pain and vigilant monitoring was done. The patient was shifted to the ward on the 3rd day and was discharged on the 5th day. To conclude, combined spinal-epidural along with invasive cardiac monitoring is a reasonable choice for elderly patients with permanent pacemakers coming for major orthopedic surgeries.
{"title":"Anesthesia management of an elderly patient having permanent pacemaker for total hip replacement","authors":"S. Govindswamy, S. Geetha","doi":"10.4103/2394-6954.180655","DOIUrl":"https://doi.org/10.4103/2394-6954.180655","url":null,"abstract":"Elderly patients with serious cardiac problems are presenting for major orthopedic surgeries. We present a case of an elderly male patient posted for total hip replacement having a permanent pacemaker in situ in ventricle paced, ventricle sensed, pacing inhibited (VVI) mode. The patient, on preoperative examination, was found to have a complete atrioventricular (AV) block on electrocardiogram (ECG) and electrophysiology study showed degenerative AV conduction disease and symptomatic complete AV block. The patient had seizure disorder and anemia, for which the patient was treated accordingly and optimized before surgery. The pacemaker mode changed to vesiculo-vacuolar organelle (VVO). Combined spinal-epidural was given. Arterial line was secured and the patient was monitored hemodynamically. The patient tolerated the procedure of total hip replacement well; vitals were maintained within 20% of the baseline. Phenylephrine infusion was given to maintain blood pressure. After operation was shifted to the intensive care unit (ICU), pacemaker was reprogrammed to VVI mode, and epidural infusion for pain and vigilant monitoring was done. The patient was shifted to the ward on the 3rd day and was discharged on the 5th day. To conclude, combined spinal-epidural along with invasive cardiac monitoring is a reasonable choice for elderly patients with permanent pacemakers coming for major orthopedic surgeries.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81043633","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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