Pub Date : 2015-10-01DOI: 10.4103/2394-6954.180660
H. Kapoor, Kirti Gujarkar
In the scenario of gastroendoscopic setup, sedation is meant to enhance the comfort of the patient and to allay anxiety associated with the procedure. Most of the procedures under gastroendoscopic setup are performed on daycare basis; hence, the drugs with shorter half-life and which are easily metabolized are preferred. Dexmedetomidine is an attractive alternative to sedatives when the patient needs to be spontaneously breathing and easily arousable from sedation.
{"title":"Future of dexmedetomidine in gastrointestinal endoscopy","authors":"H. Kapoor, Kirti Gujarkar","doi":"10.4103/2394-6954.180660","DOIUrl":"https://doi.org/10.4103/2394-6954.180660","url":null,"abstract":"In the scenario of gastroendoscopic setup, sedation is meant to enhance the comfort of the patient and to allay anxiety associated with the procedure. Most of the procedures under gastroendoscopic setup are performed on daycare basis; hence, the drugs with shorter half-life and which are easily metabolized are preferred. Dexmedetomidine is an attractive alternative to sedatives when the patient needs to be spontaneously breathing and easily arousable from sedation.","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":"81439717","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: 10.4103/2394-6954.180663
N. Raza, M. Athar, Shahna Ali, S. Ahmed
Difficult and failed intubations, although rarely encountered, are major causes of morbidity and mortality in the current anesthetic practice. To reduce the incidence of difficult and failed intubations, several devices including the recently developed video laryngoscopes are available. In this paper, we evaluated the role of newly developed McGrath® video laryngoscope in a case of postburn contracture neck, with limited neck extension and mouth opening. Anticipating difficulty in securing airway with conventional laryngoscopy, we hereby successfully used the McGrath® video laryngoscope to secure the airway. The quality of laryngoscopy and intubation showed that this portable device can be very helpful in difficult airway management.
{"title":"Feasibility of McGrath® video laryngoscope for awake laryngoscopy and intubation","authors":"N. Raza, M. Athar, Shahna Ali, S. Ahmed","doi":"10.4103/2394-6954.180663","DOIUrl":"https://doi.org/10.4103/2394-6954.180663","url":null,"abstract":"Difficult and failed intubations, although rarely encountered, are major causes of morbidity and mortality in the current anesthetic practice. To reduce the incidence of difficult and failed intubations, several devices including the recently developed video laryngoscopes are available. In this paper, we evaluated the role of newly developed McGrath® video laryngoscope in a case of postburn contracture neck, with limited neck extension and mouth opening. Anticipating difficulty in securing airway with conventional laryngoscopy, we hereby successfully used the McGrath® video laryngoscope to secure the airway. The quality of laryngoscopy and intubation showed that this portable device can be very helpful in difficult airway 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":"77873262","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: 10.4103/2394-6954.180647
Bandi Joshiraj, I. Kapoor
{"title":"A precipitous cause of iatrogenic venous air embolism in pediatric posterior fossa tumor","authors":"Bandi Joshiraj, I. Kapoor","doi":"10.4103/2394-6954.180647","DOIUrl":"https://doi.org/10.4103/2394-6954.180647","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":"83185587","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: 10.4103/2394-6954.180662
D. Murugesan, Santhi Ellakakumar, A. Muthu
A 26-year-old, 155 cm height, 72 kg primigravid female was admitted for safe confinement on December 3, 2015. She was posted for emergency lower segment cesarean section under regional anesthesia for the indication, cephalopelvic disproportion nonprogression of labor. The patient and her husband had given their consent for surgery owing to the patients' fear that she may pass out if she wept start due to pain during induced labor. Spinal anesthesia was performed at L3L4space using 27-gauge needle and 0.5% heavy bupivacaine 1.9 ml along with buprenorphine 0.1 ml. The patient was very stable hemodynamically throughout the surgical procedure which lasted for 50 min and gave birth to male baby weighing 3.2 kg. The immediate postoperative period was uneventful with stable vital signs except the patient was under deep sleep. Three hours after shifting, the patient had vomiting and three more hours later, she neither recalled having given birth nor did she recognize her baby. She exhibited violent psychiatric behavioral movements at the intervals of 3 h thereafter. Hence, the diagnosis of postpartum psychosis was suspected and managed meticulously. The patient was discharged on 7th postoperative day.
{"title":"Postpartum psychosis: Management rarely with extreme doses of drugs","authors":"D. Murugesan, Santhi Ellakakumar, A. Muthu","doi":"10.4103/2394-6954.180662","DOIUrl":"https://doi.org/10.4103/2394-6954.180662","url":null,"abstract":"A 26-year-old, 155 cm height, 72 kg primigravid female was admitted for safe confinement on December 3, 2015. She was posted for emergency lower segment cesarean section under regional anesthesia for the indication, cephalopelvic disproportion nonprogression of labor. The patient and her husband had given their consent for surgery owing to the patients' fear that she may pass out if she wept start due to pain during induced labor. Spinal anesthesia was performed at L3L4space using 27-gauge needle and 0.5% heavy bupivacaine 1.9 ml along with buprenorphine 0.1 ml. The patient was very stable hemodynamically throughout the surgical procedure which lasted for 50 min and gave birth to male baby weighing 3.2 kg. The immediate postoperative period was uneventful with stable vital signs except the patient was under deep sleep. Three hours after shifting, the patient had vomiting and three more hours later, she neither recalled having given birth nor did she recognize her baby. She exhibited violent psychiatric behavioral movements at the intervals of 3 h thereafter. Hence, the diagnosis of postpartum psychosis was suspected and managed meticulously. The patient was discharged on 7th postoperative day.","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":"89759904","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: 10.4103/2394-6954.180646
Ankur Sharma, R. Sinha, Varuna Vyas, B. Ray
We report a 40-year-old male patient who underwent thoracolaprotomy for liver and lung hydatid cyst. The patient had severe intraoperative anaphylaxis, which was managed successfully.
我们报告一位四十岁的男性病患，因肝及肺包虫病而行开胸术。患者有严重的术中过敏反应，治疗成功。
{"title":"Suspected intraoperative anaphylactic reaction caused by a hepatic and pulmonary hydatid cyst","authors":"Ankur Sharma, R. Sinha, Varuna Vyas, B. Ray","doi":"10.4103/2394-6954.180646","DOIUrl":"https://doi.org/10.4103/2394-6954.180646","url":null,"abstract":"We report a 40-year-old male patient who underwent thoracolaprotomy for liver and lung hydatid cyst. The patient had severe intraoperative anaphylaxis, which was managed successfully.","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":"85133304","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: 10.4103/2394-6954.180654
V. Singh, Rajeev Ratan
Ebstein anomaly along with restrictive cardiomyopathy is a rare entity characterized by apical displacement of the septal and posterior tricuspid valve leaflets, leading to atrialization of the right ventricle with a variable degree of malformation and displacement of the anterior leaflet along with the restriction of diastolic filling of ventricles. If patients with this anomaly present to us along atrial fibrillation and liver dysfunction due to right-sided heart failure, it would be a challenge for anesthesiologist to give anesthesia. Herein, we are providing a brief review of the clinical presentation and anesthetic consideration in these types of patients if they present for noncardiac surgeries.
{"title":"Anesthetic management of a patient with restrictive cardiomyopathy and ebstein anomaly for femoral hernia repair","authors":"V. Singh, Rajeev Ratan","doi":"10.4103/2394-6954.180654","DOIUrl":"https://doi.org/10.4103/2394-6954.180654","url":null,"abstract":"Ebstein anomaly along with restrictive cardiomyopathy is a rare entity characterized by apical displacement of the septal and posterior tricuspid valve leaflets, leading to atrialization of the right ventricle with a variable degree of malformation and displacement of the anterior leaflet along with the restriction of diastolic filling of ventricles. If patients with this anomaly present to us along atrial fibrillation and liver dysfunction due to right-sided heart failure, it would be a challenge for anesthesiologist to give anesthesia. Herein, we are providing a brief review of the clinical presentation and anesthetic consideration in these types of patients if they present for noncardiac 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":"72862813","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: 10.4103/2394-6954.180652
D. Palamattam, S. Moningi, D. Kulkarni, G. Ramachandran
The perioperative management of a patient diagnosed with ruptured cerebral aneurysm and aortic stenosis (AS) is a challenging task for the anesthesiologist. Continuous cardiac output (CO) monitoring devices such as the FloTrac™/Vigileo™ system is a reliable measure to avoid and minimize the adverse complications of hemodynamic instability, thus favoring the outcome.
{"title":"Continuous cardiac output monitoring for hemodynamic management of a case of ruptured cerebral artery aneurysm with aortic stenosis","authors":"D. Palamattam, S. Moningi, D. Kulkarni, G. Ramachandran","doi":"10.4103/2394-6954.180652","DOIUrl":"https://doi.org/10.4103/2394-6954.180652","url":null,"abstract":"The perioperative management of a patient diagnosed with ruptured cerebral aneurysm and aortic stenosis (AS) is a challenging task for the anesthesiologist. Continuous cardiac output (CO) monitoring devices such as the FloTrac™/Vigileo™ system is a reliable measure to avoid and minimize the adverse complications of hemodynamic instability, thus favoring the 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":"89976781","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: 10.4103/2394-6954.180648
Anil Bargur, N. Dixit, Latha John, Arpana Kedlaya
Background: Lumbar spine surgery in adults is associated with significant blood loss, often requiring allogeneic blood transfusion. The objective of this study was to evaluate the efficacy of tranexamic acid (TXA) in reducing perioperative blood loss and transfusion requirements in patients undergoing lumbar spine fixation. Materials and Methods: Sixty adult patients were randomized to receive either a bolus of 10 mg/kg IV of TXA after induction followed by a maintenance infusion of 1 mg/kg/hr of TXA up to closure of skin, or an equivalent volume of normal saline. Outcome measures included perioperative blood loss, amount of blood transfusion, as well as postoperative hemoglobin and hematocrit levels. Results: The mean intra-operative blood loss and the amount of blood in the drains post-operatively was less in the tranexamic acid group compared to the placebo group (P =0.0001). The blood transfusions received in both the groups was not statistically significant (P = 0.362).However, clinically there was reduction of transfusion requirement in the tranexamic acid group. The drop in post-operative hemoglobin levels was statistically significant in the control group as compared to tranexamic acid group (P = 0.002). The mean duration of surgery was less in tranexamic acid group compared to the control group (P = 0.008). Conclusion: Thus, tranexamic acid is effective in reducing peri-operative blood loss and transfusion requirements .Furthermore, TXA administration was not associated with any significant complications including DVT.
{"title":"Effect of tranexamic acid on blood loss and transfusion requirements in lumbar spine fixation","authors":"Anil Bargur, N. Dixit, Latha John, Arpana Kedlaya","doi":"10.4103/2394-6954.180648","DOIUrl":"https://doi.org/10.4103/2394-6954.180648","url":null,"abstract":"Background: Lumbar spine surgery in adults is associated with significant blood loss, often requiring allogeneic blood transfusion. The objective of this study was to evaluate the efficacy of tranexamic acid (TXA) in reducing perioperative blood loss and transfusion requirements in patients undergoing lumbar spine fixation. Materials and Methods: Sixty adult patients were randomized to receive either a bolus of 10 mg/kg IV of TXA after induction followed by a maintenance infusion of 1 mg/kg/hr of TXA up to closure of skin, or an equivalent volume of normal saline. Outcome measures included perioperative blood loss, amount of blood transfusion, as well as postoperative hemoglobin and hematocrit levels. Results: The mean intra-operative blood loss and the amount of blood in the drains post-operatively was less in the tranexamic acid group compared to the placebo group (P =0.0001). The blood transfusions received in both the groups was not statistically significant (P = 0.362).However, clinically there was reduction of transfusion requirement in the tranexamic acid group. The drop in post-operative hemoglobin levels was statistically significant in the control group as compared to tranexamic acid group (P = 0.002). The mean duration of surgery was less in tranexamic acid group compared to the control group (P = 0.008). Conclusion: Thus, tranexamic acid is effective in reducing peri-operative blood loss and transfusion requirements .Furthermore, TXA administration was not associated with any significant complications including DVT.","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":"87194357","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: 10.4103/2394-6954.173530
J. Thomas, N. Dixit, K. Kilpadi, J. Arpana
Computed-tomography guided percutaneous lung biopsy (CT-PLB) is the technique of choice for the diagnosis of pulmonary lesions and mediastinal masses. It avoids the need for more invasive procedures such as thoracotomy or open lung biopsies. This procedure can be done under local anesthesia in adults, with or without sedation. However, in children, for better patient compliance general anesthesia with endotracheal intubation and controlled ventilation is preferred. Complications associated with this procedure are hemopneumothorax, hemoptysis, pulmonary contusion, and air embolism that could be life-threatening. Guidelines suitable for providing general anesthesia in patients posted for CT-PLB are lacking and anesthesiologists must adapt their practice to handle the challenges imposed and safely deal with any resulting complications. We report a case of CT-PLB in a 6-year-old child who developed complications of hemothorax, pulmonary hemorrhage, and aspiration of blood in the opposite lung.
{"title":"CT-guided percutaneous lung biopsy in children: Complications and anesthetic management","authors":"J. Thomas, N. Dixit, K. Kilpadi, J. Arpana","doi":"10.4103/2394-6954.173530","DOIUrl":"https://doi.org/10.4103/2394-6954.173530","url":null,"abstract":"Computed-tomography guided percutaneous lung biopsy (CT-PLB) is the technique of choice for the diagnosis of pulmonary lesions and mediastinal masses. It avoids the need for more invasive procedures such as thoracotomy or open lung biopsies. This procedure can be done under local anesthesia in adults, with or without sedation. However, in children, for better patient compliance general anesthesia with endotracheal intubation and controlled ventilation is preferred. Complications associated with this procedure are hemopneumothorax, hemoptysis, pulmonary contusion, and air embolism that could be life-threatening. Guidelines suitable for providing general anesthesia in patients posted for CT-PLB are lacking and anesthesiologists must adapt their practice to handle the challenges imposed and safely deal with any resulting complications. We report a case of CT-PLB in a 6-year-old child who developed complications of hemothorax, pulmonary hemorrhage, and aspiration of blood in the opposite lung.","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":"83575232","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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