Pub Date : 2015-07-01DOI: 10.4103/2394-6954.173539
C. Sanikop, B. Hariharasudhan, M. Dhorigol
Ventricular bigeminy is a type of dysrhythmia which can complicate any pregnancy and labor. These dysrhythmias occur most commonly as sporadic occurrences in view of anxiety and can be treated by reassurance. Nevertheless, in certain cases where if they occur in an increased frequency even after adequate reassurance and primary supportive care can lead to dangerous morbidities and mortalities. We present the management of a case of 21-year-old female patient presenting with ventricular bigeminy posted for elective lower segment cesarean section in our institution. General anesthesia was considered the anesthetic modality of choice and injections loxicard and metaprolol IV were used introperatively to tackle the occurrence of ventricular ectopics. In conclusion, thorough history, clinical examination, and judicious use of antiarrhythmic agents recommended during pregnancy can prevent an asymptomatic ventricular ectopy transforming into a fatal arrhythmia in managing a case of ventricular bigeminy.
{"title":"Anesthetic management of a case of ventricular bigeminy posted for elective LSCS","authors":"C. Sanikop, B. Hariharasudhan, M. Dhorigol","doi":"10.4103/2394-6954.173539","DOIUrl":"https://doi.org/10.4103/2394-6954.173539","url":null,"abstract":"Ventricular bigeminy is a type of dysrhythmia which can complicate any pregnancy and labor. These dysrhythmias occur most commonly as sporadic occurrences in view of anxiety and can be treated by reassurance. Nevertheless, in certain cases where if they occur in an increased frequency even after adequate reassurance and primary supportive care can lead to dangerous morbidities and mortalities. We present the management of a case of 21-year-old female patient presenting with ventricular bigeminy posted for elective lower segment cesarean section in our institution. General anesthesia was considered the anesthetic modality of choice and injections loxicard and metaprolol IV were used introperatively to tackle the occurrence of ventricular ectopics. In conclusion, thorough history, clinical examination, and judicious use of antiarrhythmic agents recommended during pregnancy can prevent an asymptomatic ventricular ectopy transforming into a fatal arrhythmia in managing a case of ventricular bigeminy.","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":"73551921","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: 10.4103/2394-6954.173537
Surbhi Gupta, R. Rani, R. Nayar, Sindhu K Sridhar
Anesthetic management of a patient with penetrating thoracoabdominal trauma is a challenge for the anesthetist. Unstable hemodynamics, inadequate fasting, improper positioning for intubation, and the need for emergent surgery can complicate anesthetic management of such patients. We report a case of penetrating thoracoabdominal injury with arrow-shaped iron rods. Rapid and judicious management along with good communication between the surgeon and the anesthetist led to a successful outcome.
{"title":"Anesthetic management of a patient with penetrating thoracoabdominal trauma","authors":"Surbhi Gupta, R. Rani, R. Nayar, Sindhu K Sridhar","doi":"10.4103/2394-6954.173537","DOIUrl":"https://doi.org/10.4103/2394-6954.173537","url":null,"abstract":"Anesthetic management of a patient with penetrating thoracoabdominal trauma is a challenge for the anesthetist. Unstable hemodynamics, inadequate fasting, improper positioning for intubation, and the need for emergent surgery can complicate anesthetic management of such patients. We report a case of penetrating thoracoabdominal injury with arrow-shaped iron rods. Rapid and judicious management along with good communication between the surgeon and the anesthetist led to a successful outcome.","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":"73880747","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: 10.4103/2394-6954.173529
S. Biswal, S. Moningi, G. Ramachandran
Objectives: Distress and pain due to propofol injection is a very common finding. The aim of our study was to assess the efficacy with lignocaine, tramadol, and acetaminophen pretreatment to alleviate the propofol pain. Materials and Methods: Ninety American Society of Anesthesiology (ASA) I and II adults, scheduled for various elective surgical procedures under general anesthesia, were included in the study. They were randomly divided into three groups with 30 patients in each group. Group A received pretreatment with intravenous (IV) lignocaine, group B received IV tramadol, and group C received IV acetaminophen. One-fourth of the total calculated induction dose of propofol was administered over a period of 5 s. The patients were asked about the pain on injection. The intensity of pain was assessed using verbal rating score. A score of 0–3, which corresponded to no, mild, moderate, and severe pain was recorded. Categorical and continuous variables were compared between the groups using Chi-square test and analysis of variance (ANOVA) test, respectively. Post hoc analysis was performed using Bonferroni test. Verbal rating scale (VRS), an ordered categorical variable, was compared between the groups using Wilcoxon signed-rank test. A P value of <0.05 was considered significant. Results: All the three drugs reduced the incidence and intensity of pain on propofol injection but the order of efficacy in attenuation of pain on the propofol injection was lignocaine > tramadol = acetaminophen. Conclusion: Both tramadol and acetaminophen were clinically equivalent to lignocaine in their potency to decrease the incidence of propofol pain.
{"title":"Effect of intravenous tramadol, acetaminophen in attenuating pain on propofol injection: Comparison with lignocaine: A randomized, Double-blind, controlled study","authors":"S. Biswal, S. Moningi, G. Ramachandran","doi":"10.4103/2394-6954.173529","DOIUrl":"https://doi.org/10.4103/2394-6954.173529","url":null,"abstract":"Objectives: Distress and pain due to propofol injection is a very common finding. The aim of our study was to assess the efficacy with lignocaine, tramadol, and acetaminophen pretreatment to alleviate the propofol pain. Materials and Methods: Ninety American Society of Anesthesiology (ASA) I and II adults, scheduled for various elective surgical procedures under general anesthesia, were included in the study. They were randomly divided into three groups with 30 patients in each group. Group A received pretreatment with intravenous (IV) lignocaine, group B received IV tramadol, and group C received IV acetaminophen. One-fourth of the total calculated induction dose of propofol was administered over a period of 5 s. The patients were asked about the pain on injection. The intensity of pain was assessed using verbal rating score. A score of 0–3, which corresponded to no, mild, moderate, and severe pain was recorded. Categorical and continuous variables were compared between the groups using Chi-square test and analysis of variance (ANOVA) test, respectively. Post hoc analysis was performed using Bonferroni test. Verbal rating scale (VRS), an ordered categorical variable, was compared between the groups using Wilcoxon signed-rank test. A P value of <0.05 was considered significant. Results: All the three drugs reduced the incidence and intensity of pain on propofol injection but the order of efficacy in attenuation of pain on the propofol injection was lignocaine > tramadol = acetaminophen. Conclusion: Both tramadol and acetaminophen were clinically equivalent to lignocaine in their potency to decrease the incidence of propofol pain.","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":"73251206","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: 10.4103/2394-6954.173540
Jasvinder K Kohli, Alka S. Gupta, Sukhyanti Kerai, Yogita Mosalpuria
The combination of congenital hydrocephalus and congenital heart disease in children is infrequent. It poses considerable challenge to the anesthetist during emergency ventriculoperitoneal shunt surgery. This case report highlights the challenges encountered and successful management in acyanotic congenital heart disease with bicuspid aortic valve neonate.
{"title":"Ventriculoperitonial shunt surgery in a neonate with atrial septal defect, ventricular septal defect, patent ductus arteriosus, MILD PS, and bicuspid aortic valve","authors":"Jasvinder K Kohli, Alka S. Gupta, Sukhyanti Kerai, Yogita Mosalpuria","doi":"10.4103/2394-6954.173540","DOIUrl":"https://doi.org/10.4103/2394-6954.173540","url":null,"abstract":"The combination of congenital hydrocephalus and congenital heart disease in children is infrequent. It poses considerable challenge to the anesthetist during emergency ventriculoperitoneal shunt surgery. This case report highlights the challenges encountered and successful management in acyanotic congenital heart disease with bicuspid aortic valve neonate.","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":"76281985","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: 10.4103/2394-6954.173534
N. Dixit, B. George, M. Manjuladevi, Vineesh K. Varghese, Archana Kalaichelvam
Morquio syndrome with skeletal and extraskeletal manifestations is an anesthetic challenge. Airway management in children with Morquio syndrome can pose added risks of atlantoaxial instability, spinal cord compression, and distorted airway anatomy, leading to difficult mask ventilation and intubation. We report the anesthetic management of a 4-year-old child with Morquio syndrome who presented with acute cord compression and underwent emergency decompression of the stenotic spinal canal at the craniovertebral junction. Thorough preoperative evaluation, meticulous planning, and vigilant monitoring in the perioperative period are essential for safe anesthetic management.
{"title":"Morquio syndrome with acute cord compression: An anesthetic challenge","authors":"N. Dixit, B. George, M. Manjuladevi, Vineesh K. Varghese, Archana Kalaichelvam","doi":"10.4103/2394-6954.173534","DOIUrl":"https://doi.org/10.4103/2394-6954.173534","url":null,"abstract":"Morquio syndrome with skeletal and extraskeletal manifestations is an anesthetic challenge. Airway management in children with Morquio syndrome can pose added risks of atlantoaxial instability, spinal cord compression, and distorted airway anatomy, leading to difficult mask ventilation and intubation. We report the anesthetic management of a 4-year-old child with Morquio syndrome who presented with acute cord compression and underwent emergency decompression of the stenotic spinal canal at the craniovertebral junction. Thorough preoperative evaluation, meticulous planning, and vigilant monitoring in the perioperative period are essential for safe anesthetic management.","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":"87157535","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: 10.4103/2394-6954.173533
M. Chakravarthy, A. Gopalakrishna
{"title":"Unusual foreign body in the throat of a pre surgical demented patient","authors":"M. Chakravarthy, A. Gopalakrishna","doi":"10.4103/2394-6954.173533","DOIUrl":"https://doi.org/10.4103/2394-6954.173533","url":null,"abstract":"","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73599975","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: 10.4103/2394-6954.173542
Shivakumar Kumbar
{"title":"Medico legal aspects of Pre- and postoperative periods: What should the anesthesiologist know?","authors":"Shivakumar Kumbar","doi":"10.4103/2394-6954.173542","DOIUrl":"https://doi.org/10.4103/2394-6954.173542","url":null,"abstract":"","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91090466","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: 10.4103/2394-6954.173543
R. Arun
Laser anesthesia is a rising star in our field of anesthesiology and we as anesthesiologists should have an in-depth knowledge about laser and the pitfalls that may await us. The drive for me to write this article is to throw light in the area of laser, dangers of the medical laser, and precautions to be taken to ensure their proper use. We can prevent the potential hazards by ensuing proper preoperative evaluation, formulating protocols, early recognition of the catastrophic events, and swift actions. Here I have discussed a case of glottic carcinoma stage IA planned for laser excision of the growth. We have taken all the preoperative stringent measures necessary for the laser surgery the previous day. Emergency airway gadgets were kept ready in case of difficult intubation. The patient was intubated with the Mallinckrodt endotracheal (ET) tube and surgery was done under general anesthesia with controlled ventilation using Vecuronium injection + N2O + medical air. The intraoperative period was uneventful. The patient was extubated after adequate reversal and the postoperative recovery was uneventful.
{"title":"Lasers in anesthesia","authors":"R. Arun","doi":"10.4103/2394-6954.173543","DOIUrl":"https://doi.org/10.4103/2394-6954.173543","url":null,"abstract":"Laser anesthesia is a rising star in our field of anesthesiology and we as anesthesiologists should have an in-depth knowledge about laser and the pitfalls that may await us. The drive for me to write this article is to throw light in the area of laser, dangers of the medical laser, and precautions to be taken to ensure their proper use. We can prevent the potential hazards by ensuing proper preoperative evaluation, formulating protocols, early recognition of the catastrophic events, and swift actions. Here I have discussed a case of glottic carcinoma stage IA planned for laser excision of the growth. We have taken all the preoperative stringent measures necessary for the laser surgery the previous day. Emergency airway gadgets were kept ready in case of difficult intubation. The patient was intubated with the Mallinckrodt endotracheal (ET) tube and surgery was done under general anesthesia with controlled ventilation using Vecuronium injection + N2O + medical air. The intraoperative period was uneventful. The patient was extubated after adequate reversal and the postoperative recovery was uneventful.","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":"80735185","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: 10.4103/2394-6954.173531
Alok Narasimha, N. Dixit, Latha John, S. Cherian
Diamond-Blackfan anemia (DBA) is a rare congenital disorder that can pose a variety of anesthetic challenges to a clinician. A disorder of pure red cell aplasia is associated with other congenital anomalies such as craniofacial malformations, thumb or upper limb abnormalities, cardiac defects, urogenital malformations, and cleft palate. These anomalies are compounded by problems of iron overload and chronic steroid therapy. Anesthetic management of a child with DBA requires knowledge and skill to handle a difficult pediatric airway and a thorough understanding of the congenital heart lesion of the child and its interaction with anesthetic agents and surgery. Rarity of DBA, along with its associated problems and lack of awareness of these by the anesthesiologist, makes the occasional surgery in this population very challenging. We report a 1-year 3-month-old child, diagnosed to have DBA during infancy, posted for laparoscopic orchidopexy.
{"title":"Anesthetic management of a child with Diamond-Blackfan syndrome","authors":"Alok Narasimha, N. Dixit, Latha John, S. Cherian","doi":"10.4103/2394-6954.173531","DOIUrl":"https://doi.org/10.4103/2394-6954.173531","url":null,"abstract":"Diamond-Blackfan anemia (DBA) is a rare congenital disorder that can pose a variety of anesthetic challenges to a clinician. A disorder of pure red cell aplasia is associated with other congenital anomalies such as craniofacial malformations, thumb or upper limb abnormalities, cardiac defects, urogenital malformations, and cleft palate. These anomalies are compounded by problems of iron overload and chronic steroid therapy. Anesthetic management of a child with DBA requires knowledge and skill to handle a difficult pediatric airway and a thorough understanding of the congenital heart lesion of the child and its interaction with anesthetic agents and surgery. Rarity of DBA, along with its associated problems and lack of awareness of these by the anesthesiologist, makes the occasional surgery in this population very challenging. We report a 1-year 3-month-old child, diagnosed to have DBA during infancy, posted for laparoscopic orchidopexy.","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":"73741450","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: 10.4103/2394-6954.173526
Soumya Srikumar, S. Rajan, J. Paul, L. Kumar
{"title":"General anesthesia in a patient with multiple drug allergy","authors":"Soumya Srikumar, S. Rajan, J. Paul, L. Kumar","doi":"10.4103/2394-6954.173526","DOIUrl":"https://doi.org/10.4103/2394-6954.173526","url":null,"abstract":"","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74034581","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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