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Anaesthetic Management Of A Patient With Varicella Undergoing Emergency Caesarean Section 紧急剖宫产一例水痘患者的麻醉处理
Pub Date : 2012-01-24 DOI: 10.5580/2a5d
S. Kaur, Suman Shekhawat
We report a case of 27 year old primigravida at 39 weeks gestation suffering from chicken pox requiring emergency caesarean section that was managed with general anaesthesia. Anaesthetic management and clinical implications are discussed here.
我们报告一例27岁的初产妇在妊娠39周患水痘需要紧急剖宫产是管理与全身麻醉。这里讨论麻醉管理和临床意义。
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引用次数: 0
Spectrum Of Head And Neck Swellings In The Rural Population Of India Based On Fine Needle Aspiration Findings 基于细针抽吸结果的印度农村人口头颈部肿胀谱
Pub Date : 2012-01-24 DOI: 10.5580/2c45
U. Jindal, Karanprit Singh, Aditi Baghla, A. Kochhar
Introduction:Head and Neck swellings are of great clinical significance as underlying disease may range from a treatable infectious etiology to malignant neoplasm. In fact it is also essential to establish the origin of swelling in question sometimes. Fine needle aspiration cytology plays a vital role in solving all this issues, and fine needle aspiration cytology is now being recognized as a rapid diagnostic technique because of its simplicity and high accuracy.Aim:This retrospective study was carried out at the Department of Pathology, Maharaja Agrasen Medical Collage, Agroha for a period of Dec 2010 to Dec 2011. The aim was to know the pattern and frequency of head and neck swelling in rural Indian population, and also to know the distribution of these lesions in relation to age and sex.Result:A total of 350 cases of head and neck swelling were observed during this period. Age of presentation varied from 1 year to 85 years with male to female ratio of 1.13 to 1. Lymph node enlargement was the commonest cause (50.85%), followed by thyroid lesions (22.85%). Salivary gland lesions comprised 8.5% of all lesions. Tuberculosis/Granulomatous lymphadenitis were the most common lesion observed constituting 19.14 %( n=67) followed by malignant Neoplasm comprising 17.15 %( n=60) among all lesions. Other common cause of swelling in region observed were due to Reactive lymphadenitis (16.85%, n =59), Thyroid Goiter (16%, n=56), Cystic lesion (7.42%n=26) and Abscess/inflammatory lesion (8.28% n=29).Conclusion:During the first three decades, most of the swelling of the head and neck region was either due to Tuberculosis/Granulomatous lymphadenitis or due to Reactive lymphadenitis. While in later decades i.e. 4 th to 6 th decades, most of the swelling is due to Metastatic carcinoma. Fine needle aspiration cytology is useful in diagnosis and differentiating Neoplastic and Non Neoplastic lesions.
头颈部肿胀具有重要的临床意义,因为其潜在疾病可能是可治疗的感染性病因,也可能是恶性肿瘤。事实上,有时确定肿胀的起源也是必要的。细针吸细胞学在解决这些问题中起着至关重要的作用,细针吸细胞学因其简单、准确而被公认为是一种快速诊断技术。目的:本回顾性研究于2010年12月至2011年12月在Agroha Maharaja Agrasen医学院病理学系进行。目的是了解印度农村人口头颈部肿胀的模式和频率,并了解这些病变在年龄和性别方面的分布。结果:共观察到350例头颈部肿胀。发病年龄从1岁到85岁不等,男女比例为1.13:1。淋巴结肿大是最常见的原因(50.85%),其次是甲状腺病变(22.85%)。唾液腺病变占所有病变的8.5%。结核/肉芽肿性淋巴结炎是最常见的病变,占19.14% (n=67),其次是恶性肿瘤,占17.15% (n=60)。其他常见的肿胀原因为反应性淋巴结炎(16.85%,n= 59)、甲状腺甲状腺肿(16%,n=56)、囊性病变(7.42%,n=26)和脓肿/炎症性病变(8.28%,n=29)。结论:头30年,头颈部肿大多为结核性/肉芽肿性淋巴结炎或反应性淋巴结炎所致。而在以后的几十年,即第4至60年,大多数肿胀是由于转移性癌。细针吸细胞学在诊断和鉴别肿瘤和非肿瘤病变方面是有用的。
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引用次数: 18
Ultrasound Guided Vascular Access and Unusual Complications – Two Case Reports 超声引导血管通路及异常并发症2例报告
Pub Date : 2012-01-24 DOI: 10.5580/2b15
A. Riyat, R. Baikady
Ultrasound is being increasingly used to aid the placement of central venous catheters and has been demonstrated to decrease associated complications. However, catheter tip placement is not guaranteed using ultrasound, as we describe in two case reports. The first case described a central venous catheter passing into a tributary of the left brachiocephalic vein, and the second case describes the catheter tip close to the jugular bulb. We conclude with a discussion exploring the potential issues of left internal jugular vein catheterisation and inadvertent retrograde passage towards the jugular bulb.
超声越来越多地用于辅助中心静脉导管的放置,并已被证明可以减少相关并发症。然而,正如我们在两个病例报告中所描述的那样,使用超声不能保证导管尖端的放置。第一个病例描述了一个中心静脉导管进入左头臂静脉的分支,第二个病例描述了导管尖端靠近颈静脉球。最后,我们讨论了左颈内静脉置管和无意中向颈内静脉球逆行通道的潜在问题。
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引用次数: 0
Arrow Shot Injury To The Neck 颈部中箭受伤
Pub Date : 2012-01-24 DOI: 10.5580/2a77
Sandabe Mb., Waziri Am., Akinniran Aa., A. Jatta, Chibuzo Im.
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引用次数: 1
Comparison Of Epidural Bupivacaine 0.5% With Epidural Ropivacaine 0.75% For Lower Limb Orthopedic Procedures 0.5%布比卡因硬膜外与0.75%罗比卡因硬膜外用于下肢骨科手术的比较
Pub Date : 2012-01-24 DOI: 10.5580/2b16
S. Shaikh, K. Rohini
Epidural blockade is becoming one of the most useful and versatile procedures in modern anesthesiology. Bupivacaine is a long acting amide local anaesthetic which is widely used since many years. However, it is associated with a number of side effects like Central Nervous System (CNS) toxicity and cardiotoxicity. Ropivacaine is a newly introduced long acting amide local anaesthetic drug in India which has been developed as a possible alternative to Bupivacaine. It has a lower lipophilicity than bupivacaine and hence associated with a decreased potential for CNS and cardiotoxicity. AimsThe aim of the study was to compare the time of onset of sensory block and duration of sensory and motor blockade of epidural anaesthesia produced by bupivacaine 0.5% and ropivacaine 0.75% for lower limb surgery.Methods60 patients, aged between 18-60 years, ASA 1 and 2, undergoing various lower limb surgeries were randomly allocated to 2 groups of 30 each. Group A received 15ml of 0.75% ropivacaine and group B received 15 ml of 0.5% bupivacaine epidurally. The time for loss of pinprick at T10, intensity of motor block, duration of sensory and motor block and hemodynamic changes were assessed.Results1. The time of onset and duration of sensory block was comparable for both the drugs.2. Bupivacaine 0.5% produced more intensity and longer duration of motor block than ropivacaine 0.75%3. Both the drugs were comparable with respect to hemodynamic changes.ConclusionEpidural ropivacaine 0.75% can be safely used as a possible alternative to bupivacaine 0.5% in lower limb orthopedic procedures.
硬膜外阻滞正成为现代麻醉学中最有用和最通用的手术之一。布比卡因是一种长效酰胺类局部麻醉剂,多年来被广泛应用。然而,它与许多副作用有关,如中枢神经系统(CNS)毒性和心脏毒性。罗哌卡因是印度新近引进的长效酰胺局部麻醉药物,已被开发为布比卡因的可能替代品。它的亲脂性比布比卡因低,因此与中枢神经系统和心脏毒性的潜在降低有关。目的:比较0.5%布比卡因和0.75%罗比卡因在下肢手术硬膜外麻醉中产生感觉阻滞的起效时间和感觉及运动阻滞的持续时间。方法将60例年龄18 ~ 60岁,ASA 1 ~ 2级,接受各种下肢手术的患者随机分为两组,每组30例。A组应用0.75%罗哌卡因15ml, B组应用0.5%布比卡因15ml。观察T10针刺消失时间、运动阻滞强度、感觉和运动阻滞持续时间及血流动力学变化。两种药物的感觉阻滞起效时间和持续时间相当。0.5%布比卡因比0.75%罗比卡因产生的运动阻滞强度更大,持续时间更长。两种药物在血流动力学变化方面具有可比性。结论0.75%罗哌卡因硬膜外麻醉可替代0.5%布比卡因在下肢骨科手术中安全使用。
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引用次数: 5
Comparison Of Palonosetron With Placebo For Prevention Of Postoperative Nausea And Vomiting In Female Patients Undergoing Gynaecological Surgery Under Spinal Anaesthesia. 帕洛诺司琼与安慰剂预防脊柱麻醉妇科手术女性患者术后恶心呕吐的比较。
Pub Date : 2012-01-24 DOI: 10.5580/2a5a
Sushma. K.S, S. Shaikh
Background: Postoperative Nausea and Vomiting (PONV) can be a distressing problem in patients undergoing regional anaesthesia also, as patient and surgical risk factors for PONV continue to exist. In this randomized, double blind, prospective clinical study, we investigated and compared the efficacy of newer 5HT3 antagonist Palonosetron, compared to placebo, in preventing Postoperative Nausea and Vomiting in patients undergoing gynaecological surgeries under spinal anaesthesia.Material and Methods: 70 women, ASA 1 and 2, undergoing gynaecological surgeries, with risk for PONV (>/= 2 risk score) were randomly allocated to two groups containing 35 patients each. One group received 0.075mg of Palonosetron intravenously and other group received saline intravenously as placebo after administration of spinal anaesthesia. Peri-operative anesthetic care was standardized in all patients. The efficacy of study medication was assessed in terms of Complete Response (No emesis and no rescue antiemetic), incidence of emetic episodes, the incidence and severity of nausea in the postoperative study periods 0-6 hours, 6-24 hours and 24-72 hours. Results: The incidence of a Complete Response (no emesis, no rescue antiemetic) in 0-6 hour study period was 82.9% with palonosetron group and 45.7%with placebo group (P value-0.001 strongly significant).The corresponding incidence in 6-24 hour was 74.3% with palonosetron and 37.1% with placebo group (P value 0.002 strongly significant).During 24-72 hour, the incidence was 97.1% in palonosetron and 94.3% in the placebo group (P value not significant).Conclusion: A single intravenous dose of 0.075mg of Palonosetron significantly reduced emesis, nausea and use of rescue anti-emetics in female patients undergoing gynaecological surgeries under spinal anaesthesia compared to placebo.
背景:术后恶心和呕吐(PONV)也是区域麻醉患者的一个困扰问题,因为PONV的患者和手术危险因素仍然存在。在这项随机、双盲、前瞻性临床研究中,我们调查并比较了新型5HT3拮抗剂帕洛诺司琼与安慰剂在预防脊柱麻醉下妇科手术患者术后恶心和呕吐方面的疗效。材料与方法:将70例ASA 1级和ASA 2级的有PONV风险(风险评分>/= 2)的行妇科手术的妇女随机分为两组,每组35例。一组脊髓麻醉后静脉注射0.075mg帕洛诺司琼,另一组脊髓麻醉后静脉注射生理盐水作为安慰剂。所有患者的围手术期麻醉护理均标准化。在术后0-6小时、6-24小时和24-72小时研究期间,根据完全缓解(无呕吐和无抢救止吐药)、呕吐发作发生率、恶心发生率和严重程度评估研究药物的疗效。结果:帕洛诺司琼组0 ~ 6小时的完全缓解(无呕吐、无抢救止吐药)发生率为82.9%,安慰剂组为45.7% (P值0.001有显著性差异)。帕洛诺司琼组6 ~ 24小时的相应发生率为74.3%,安慰剂组为37.1% (P值为0.002)。在24-72小时内,帕洛诺司琼组的发生率为97.1%,安慰剂组为94.3% (P值无统计学意义)。结论:与安慰剂相比,单次静脉注射0.075mg帕洛诺司琼可显著减少女性脊柱麻醉妇科手术患者的呕吐、恶心和抢救止吐药的使用。
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引用次数: 0
Accidental Injection Of Tranexamic Acid Into Subarachnoid Space Leading To Fatal Outcome: Case Report And Review 氨甲环酸意外注射至蛛网膜下腔致死亡:个案报告及回顾
Pub Date : 2012-01-24 DOI: 10.5580/2b75
U. Srivastava, K. Joshi, Vishal Gupta, Amrita Gupta, N. Chauhan, A. Dupargude, A. Saxena, A. Saxena
Medication error leading to significant morbidity and mortality is a cause of great concern. We are reporting a case where a patient received spinal anaesthesia with tranexamic acid by mistake due to similarity between ampoules of bupivacaine and tranexamic acid and had fatal outcome.
导致严重发病率和死亡率的用药错误引起了人们的高度关注。我们报告一个病例,由于布比卡因和氨甲环酸的安瓿相似,患者错误地接受了氨甲环酸脊髓麻醉,并产生了致命的结果。
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引用次数: 8
A Prospective Randomised Study Of Combination Of Epidural Bupivacaine With Clonidine And Bupivacaine For Postoperative Analgesia 硬膜外布比卡因联合可乐定和布比卡因用于术后镇痛的前瞻性随机研究
Pub Date : 2012-01-24 DOI: 10.5580/2b74
Jyothi, H. Verma, S. Safiya
After obtaining institutional ethical committee approval and written informed consent, 90 adult patients, ages 30-75 yrs, of either gender belonging to ASA physical status 1 and 2 scheduled for abdominal, obstetrical, gynecological and orthopedic surgery under epidural anaesthesia, during the study period (Jan 2009 Dec 2009) were recruited. Patients for whom central neuraxial block was contraindicated and those with history of poorly controlled hypertension, angina, congestive cardiac failure, atrial fibrillation, arrhythmias, weight >95kg, age >75years, ASA grade 3 and 4, on tricyclic anti-depressants, alpha-2 adrenergic agonists or opioids were excluded from this study.
在获得机构伦理委员会批准和书面知情同意后,在研究期间(2009年1月至2009年12月)招募90名年龄30-75岁的成人患者,无论性别,均属于ASA身体状态1和2,计划在硬膜外麻醉下进行腹部、产科、妇科和骨科手术。中枢神经轴传导阻滞禁忌症、有控制不良高血压、心绞痛、充血性心力衰竭、房颤、心律失常病史、体重>95kg、年龄>75岁、ASA 3级和4级、服用三环抗抑郁药、α -2肾上腺素能激动剂或阿片类药物的患者排除在本研究之外。
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引用次数: 3
Effect Of LMA-Classic And LMA-Proseal Insertion On Intraocular Pressure In Adult Patients. lma -经典和LMA-Proseal植入对成人眼压的影响。
Pub Date : 2012-01-24 DOI: 10.5580/2ac8
Promila Phaughat, S. Kiran, A. Khurana, S. Hooda
Background: One of the primary aims of anaesthetic management during ophthalmic surgery is to provide optimal control of intraocular pressure (IOP). Laryngeal mask airway (LMA)-classic and LMA-ProSeal have been compared on many aspects but we could not locate any trials comparing the effect of their insertion on IOP. Present study compared effect of LMA-classic and LMA-ProSeal insertion on the IOP. Methods: 100 patients requiring general anaesthesia for elective surgical procedures were divided into two groups (LMA-classic in 50 patients and LMA-ProSeal in 50 patients). Baseline IOP was recorded and after induction, LMA insertion was performed. Anaesthesia was maintained with nitrous oxide and halothane in oxygen. IOP was measured just before LMA insertion, just after LMA insertion and thereafter at intervals of 1, 3 and 5 minutes. Results: IOP decreased in both groups after induction with propofol (p value> 0.05). It rose just after the insertion of airway device in both the groups (p value>0.05). At one minute after the device insertion IOP started decreasing (p value>0.05). At 3 minutes and 5 minutes after the insertion of airway device the IOP was still decreasing in both the groups and was not significantly different. Conclusion: Results of the present study show that IOP always remains below baseline with the use of LMA-classic as well as LMA-ProSeal. The study showed similar profile of two devices as far as IOP is concerned.
背景:眼科手术麻醉管理的主要目的之一是提供最佳控制眼压(IOP)。经典喉罩气道(LMA -classic)和proseal喉罩气道(LMA - proseal)在许多方面进行了比较,但我们无法找到任何比较其插入对IOP影响的试验。本研究比较了LMA-classic和LMA-ProSeal植入术对IOP的影响。方法:择期手术全麻患者100例分为两组(LMA-classic组50例,LMA-ProSeal组50例)。记录基线IOP,诱导后进行LMA插入。在氧气中使用氧化亚氮和氟烷维持麻醉。在LMA插入前、LMA插入后以及之后每隔1分钟、3分钟和5分钟测量IOP。结果:两组患者经异丙酚诱导后眼压均下降(p值0.05)。两组均在刚插入气道装置后升高(p值>.05)。插入装置1分钟后IOP开始下降(p值>0.05)。在插管后3分钟和5分钟,两组IOP仍在下降,差异无统计学意义。结论:本研究结果表明,使用LMA-classic和LMA-ProSeal时,IOP始终低于基线。该研究显示,就IOP而言,两种设备的情况相似。
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引用次数: 1
A Rare Complication Of Colonoscopy: Subarachnoid Hemorrhage 结肠镜检查的罕见并发症:蛛网膜下腔出血
Pub Date : 2012-01-24 DOI: 10.5580/2afd
Oya Ünsal, H. Türk, M. Açık, P. Sayın, N. Ediz, S. Oba
Colonoscopy-induced neurological complications are very rare, but they have high mortality and morbidity rates. Subarachnoid hemorrhage, which was the complication of colonoscopy, was reported in 1 case in literature and ended with death. We report this survived case to discuss this rare complication and emphasize the management of subarachnoid hemorrhage.
结肠镜检查引起的神经系统并发症是非常罕见的,但它们有很高的死亡率和发病率。文献报道结肠镜检查并发症蛛网膜下腔出血1例,最终死亡。我们报告这个幸存的病例来讨论这种罕见的并发症,并强调蛛网膜下腔出血的处理。
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引用次数: 1
期刊
The Internet Journal of Anesthesiology
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