Although neuroendoscopy has become popular both as an independent treatment modality and as an adjunct to micro‐neurosurgery for various neurologic disorders, yet we have very sparse literature about basic anaesthesia concepts for this particular technique. Anaesthesiologists can positively contribute to overall neurologic outcome of these procedures through attention to the medical condition of the patient, the basic surgical requirements, specific anaesthetic requirements, and heightened awareness of specific intraoperative and postoperative risks. General anaesthesia with endotracheal intubation remains the technique of choice. Though this is a minimally invasive procedure, invasive haemodynamic monitoring should be done as there is high incidence of haemodynamic instabilities during these procedures. Direct or indirect measurement of ICP is crucial to identify sudden and dangerous increases in ICP. Bradycardia is the commonest arrhythmia seen intraoperatively and generally responds to simple manoeuvres like removal of scope, decreasing the speed of inflow of irrigation fluid and allowing its egress. Use of atropine and other resuscitative measures are needed rarely. Warmed lactated ringer solution can be safely used for intraoperative irrigation with minimal postoperative impact. Close observation of vital signs, serum electrolytes as well as volume and temperature of the irrigation fluid and close communication between anesthesiologist and surgeon, are prerequisites for better outcome. Close postoperative monitoring is required to diagnose and treat complications such as convulsions, persistent hydrocephalus, blocked stoma, CSF leak, haemorrhage, post‐operative intracranial haematomas, diabetes insipidus, electrolyte imbalance, infections etc. thus improving overall outcome.
{"title":"Neuroendoscopy: What an Anaesthesiologist Should Know?","authors":"Hemlata","doi":"10.23880/accmj-16000157","DOIUrl":"https://doi.org/10.23880/accmj-16000157","url":null,"abstract":"Although neuroendoscopy has become popular both as an independent treatment modality and as an adjunct to micro‐neurosurgery for various neurologic disorders, yet we have very sparse literature about basic anaesthesia concepts for this particular technique. Anaesthesiologists can positively contribute to overall neurologic outcome of these procedures through attention to the medical condition of the patient, the basic surgical requirements, specific anaesthetic requirements, and heightened awareness of specific intraoperative and postoperative risks. General anaesthesia with endotracheal intubation remains the technique of choice. Though this is a minimally invasive procedure, invasive haemodynamic monitoring should be done as there is high incidence of haemodynamic instabilities during these procedures. Direct or indirect measurement of ICP is crucial to identify sudden and dangerous increases in ICP. Bradycardia is the commonest arrhythmia seen intraoperatively and generally responds to simple manoeuvres like removal of scope, decreasing the speed of inflow of irrigation fluid and allowing its egress. Use of atropine and other resuscitative measures are needed rarely. Warmed lactated ringer solution can be safely used for intraoperative irrigation with minimal postoperative impact. Close observation of vital signs, serum electrolytes as well as volume and temperature of the irrigation fluid and close communication between anesthesiologist and surgeon, are prerequisites for better outcome. Close postoperative monitoring is required to diagnose and treat complications such as convulsions, persistent hydrocephalus, blocked stoma, CSF leak, haemorrhage, post‐operative intracranial haematomas, diabetes insipidus, electrolyte imbalance, infections etc. thus improving overall outcome.","PeriodicalId":313122,"journal":{"name":"Anaesthesia & Critical Care Medicine Journal","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114134295","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}
Aim: To assess and evaluate effect of oral aprepitant and injection palonosetron for prevention of post-operative nausea vomiting [PONV] in patients posted for laparoscopic cholecystectomy under general anaesthesia. Background: Laparoscopic surgeries have been performed now a day’s very frequently. The patients undergoing laparoscopic cholecystectomy under general anaesthesia have high risk for post-operative nausea and vomiting [PONV] with incidence up to 75%. Method: 90 patients of ASA grade I and II undergoing laparoscopic cholecystectomy were registered for this study. They were divided randomly into 3groups of 30 each who received 1capsule (80 mg) aprepitant orally 3 hrs before and 2ml of normal saline IV 10 minute prior to induction in group A, or 1capsule (80 mg) aprepitant orally 3 hrs before and 2ml of normal saline IV 10 minute prior to induction in group P and placebo 1 capsule orally 3 hrs before and 2ml of normal saline intravenous (IV) 10 minute prior to induction in group C. After extubation patients were watched and monitored for nausea, retching and vomiting for 30 min., 60min, 2 hour, 6 hour, 12 hour, and 24 hour in postoperative period. Results: Palonosetron and Aprepitant both are the effective in reducing the incidence of post-operative nausea and vomiting up to 24 hours, when given prior to induction of general anaesthesia. Aprepitant is more effective than Palonosetron in reducing the nausea and vomiting in post-operative period.
{"title":"A Clinical Comparative Study of Oral Aprepitant and Injection Palonosetron for Prevention of Postoperative Nausea and Vomiting in Patients of Laparoscopic Cholecystectomy under General Anaesthesia","authors":"J. Agrawal","doi":"10.23880/accmj-16000143","DOIUrl":"https://doi.org/10.23880/accmj-16000143","url":null,"abstract":"Aim: To assess and evaluate effect of oral aprepitant and injection palonosetron for prevention of post-operative nausea vomiting [PONV] in patients posted for laparoscopic cholecystectomy under general anaesthesia. Background: Laparoscopic surgeries have been performed now a day’s very frequently. The patients undergoing laparoscopic cholecystectomy under general anaesthesia have high risk for post-operative nausea and vomiting [PONV] with incidence up to 75%. Method: 90 patients of ASA grade I and II undergoing laparoscopic cholecystectomy were registered for this study. They were divided randomly into 3groups of 30 each who received 1capsule (80 mg) aprepitant orally 3 hrs before and 2ml of normal saline IV 10 minute prior to induction in group A, or 1capsule (80 mg) aprepitant orally 3 hrs before and 2ml of normal saline IV 10 minute prior to induction in group P and placebo 1 capsule orally 3 hrs before and 2ml of normal saline intravenous (IV) 10 minute prior to induction in group C. After extubation patients were watched and monitored for nausea, retching and vomiting for 30 min., 60min, 2 hour, 6 hour, 12 hour, and 24 hour in postoperative period. Results: Palonosetron and Aprepitant both are the effective in reducing the incidence of post-operative nausea and vomiting up to 24 hours, when given prior to induction of general anaesthesia. Aprepitant is more effective than Palonosetron in reducing the nausea and vomiting in post-operative period.","PeriodicalId":313122,"journal":{"name":"Anaesthesia & Critical Care Medicine Journal","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127800701","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}
Bullae are thin walled, air filled intraparenchymal lung spaces which carries a significant risk of life-threatening complications during the perioperative period. To avoid the risk of rupture, most experts recommend the use of spontaneous ventilation or regional anaesthesia during the intraoperative period. We present the anaesthetic management of an elderly smoker with bilateral pulmonary bullae, poorly controlled diabetes, and hypertension, posted for excision of a thoracic-spine tumour under the prone position, requiring need for general anaesthesia with positive pressure ventilation. This literature review highlights the steps for pre-operative evaluation, anaesthesia planning, precautionary measures, and the protocol to be followed in the event of complications.
{"title":"Anaesthetic Challenges in Thoracic Spine Surgery with Bilateral Pulmonary Bullae: A Case Report with Literature Review","authors":"G. Jain","doi":"10.23880/accmj-16000150","DOIUrl":"https://doi.org/10.23880/accmj-16000150","url":null,"abstract":"Bullae are thin walled, air filled intraparenchymal lung spaces which carries a significant risk of life-threatening complications during the perioperative period. To avoid the risk of rupture, most experts recommend the use of spontaneous ventilation or regional anaesthesia during the intraoperative period. We present the anaesthetic management of an elderly smoker with bilateral pulmonary bullae, poorly controlled diabetes, and hypertension, posted for excision of a thoracic-spine tumour under the prone position, requiring need for general anaesthesia with positive pressure ventilation. This literature review highlights the steps for pre-operative evaluation, anaesthesia planning, precautionary measures, and the protocol to be followed in the event of complications.","PeriodicalId":313122,"journal":{"name":"Anaesthesia & Critical Care Medicine Journal","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115228638","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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