{"title":"The critical role of anaesthesia in multifaceted care for severe thoracic trauma: A case study","authors":"Sathya Narayanan K, Nikita Mamgain, Geeta Bhandari, Priyanka Chourasia, Rishika Rathore","doi":"10.18231/j.ijca.2023.081","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.081","url":null,"abstract":"Blunt trauma to the thorax can be viciously dangerous and carries high mortality which warrants aggressive resuscitation and life-saving measures failing which cardiac arrest can occur. We present a case of a polytrauma male patient in the emergency department with diaphragmatic rupture, and bilateral pelvic and clavicular fractures in hypovolemic shock which progressed to cardiac arrest. The patient was immediately resuscitated with Cardiopulmonary and cerebral resuscitation (CPCR) according to Advanced cardiac life support (ACLS) guidelines and stabilized with intravenous fluids and further optimized with blood products. He was operated on for diaphragmatic rupture and shifted to intensive care where he was paralysed and kept on mechanical ventilation for 48 hours treated for severe metabolic acidosis and hemodynamic instability following which he was weaned off successfully. During his stay, he was evaluated for pelvic and clavicular fractures and treated for ICU-related delirium and Methicillin Resistant Staphylococcus infection(MRSA). Our case suggests that diaphragmatic injuries are uncommon but deadly in cases of abdominal forceful trauma because they can result in hemothorax and the movement of intestinal contents into the thoracic cavity. Such cases must be managed with clinical knowledge employing expedient surgical care and the best critical care. This case demonstrates the indispensable and undeniable contributions by anaesthesiologists who assume multiple roles within a hospital setup.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"35 1-2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139270660","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}
{"title":"Epidural knot – A scary complication to be wary of","authors":"Teena Peter, Sachin George","doi":"10.18231/j.ijca.2023.091","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.091","url":null,"abstract":"","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"198 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139270622","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}
{"title":"Anesthetic management of difficult paediatric airway in a case of large facial Neurofibromatosis – A case report","authors":"Jyoti Nara, Naveen Yalla","doi":"10.18231/j.ijca.2023.079","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.079","url":null,"abstract":"Neurofibromatosis is tumor involving different parts of the body. Neurofibromatosis may potentially lead to difficult airway. These challenging cases need special considerations. Various anesthetic techniques and devices are described to secure the airway. In the present case we intubated a 11-year-old child with large left side facial tumor extending to the neck which had intraoral encroachment displacing the tongue and pharynx to the right. This is a case report illustrating intubation of difficult pediatrics airway using awake bronchoscopic intubation under conscious sedation.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139273203","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}
{"title":"The management of anaesthesia in pregnant patients with unknown drug allergies: A complex challenge for anaesthesiologists","authors":"Ruma Thakuria, Rashmi Ramachandran","doi":"10.18231/j.ijca.2023.090","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.090","url":null,"abstract":"","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"410 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139273815","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}
{"title":"Combined thoracic epidural anaesthesia and interscalene brachial plexus block for modified radical mastectomy in a high-risk patient","authors":"Deepak S. Phalgune, Shripad Mahadik, Sushmitha K","doi":"10.18231/j.ijca.2023.082","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.082","url":null,"abstract":"In a case of malignancy of the breast, operation is one of best option for the management of the patient. Modified radical mastectomy (MMR) is commonly conducted by giving general anaesthesia (GA). But GA is not a rational choice in patients who are suffering from bronchial asthma and other associated comorbidities. These patients have additional danger of perioperative morbidity and mortality especially because of respiratory complications. We report successful perioperative management of MMR under combined thoracic epidural anaesthesia and ipsilateral interscalene brachial plexus block in a diagnosed case of malignancy of breast with bronchial asthma, type 2 diabetes mellitus and hypertension.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"174 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139274029","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}
{"title":"Anaesthetic management of a bleeding intratracheal mass","authors":"Lalit Sehgal, Sakshi Gera, Akanksha Sharma, Ashish Vashishth","doi":"10.18231/j.ijca.2023.083","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.083","url":null,"abstract":"A long-standing thyroid mass can have varied presentation depending on the metabolic, compressive or invasive symptoms. The most apparent symptom of thyroid mass is goitre, which if ignored can prove to be catastrophic as in our case. It is uncommon for thyroid mass to present as airway bleeding. However, a patient with long standing goitre presented with frank hemoptysis to our hospital. Radiological study revealed a thyroid mass, infiltrating the tracheal wall and extending into the tracheal lumen. A bleeding intratracheal mass presents a multifactorial challenge to an anaesthetist. Authors present anaesthetic management of a case of infiltrating thyroid malignancy presenting as a bleeding intratracheal mass. The haemostasis and airway patency were restored until definitive surgery was planned. The need for tracheostomy could be avoided in this case. A meticulously planned airway management along with multi-disciplinary approach are important for management of bleeding intratracheal mass.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139274721","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}
Pranali Divekar, Shalini Saksena, Aditi Shashank Tilak, R. Bhatti
{"title":"Cardiac patient for lung surgery: Walking the tightrope","authors":"Pranali Divekar, Shalini Saksena, Aditi Shashank Tilak, R. Bhatti","doi":"10.18231/j.ijca.2023.080","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.080","url":null,"abstract":"A patient with poor cardiac function undergoing any surgery under any form of anaesthesia is at high risk for perioperative morbidity and mortality. Both open thoracic surgery and emergency laparotomy in these patients are associated with high incidence of postoperative pulmonary and cardiac complications. Perioperative assessment and multidisciplinary approach are key to managing such cases. Having a clear plan for induction, invasive monitoring, intraoperative fluid management and post-operative analgesia is important for a positive outcome. We present a case of an elective open pulmonary lobectomy and emergency laparotomy conducted within an interval of 7 days in a patient with adenocarcinoma lung and ischemic heart disease with ejection fraction of 10-15%, highlighting the perioperative challenges and management.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139272013","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}
{"title":"Should inotropes be depended on as the only savior in haemodynamic crisis? a case study of symmetrical peripheral gangrene of limb extremities in a patient with traumatic brain injury","authors":"Sagar Debbarman, Bublee Khakhlary, N. Sokhal","doi":"10.18231/j.ijca.2023.088","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.088","url":null,"abstract":"","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139273185","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}
{"title":"A rare case of myasthenia gravis in pregnancy with impending eclampsia","authors":"Eshita Singh, Radhesh Hedge","doi":"10.18231/j.ijca.2023.085","DOIUrl":"https://doi.org/10.18231/j.ijca.2023.085","url":null,"abstract":"Managing myasthenia gravis during pregnancy is challenging due to its high-risk nature, particularly among women aged 20 to 30, coinciding with childbearing age. This risk is exacerbated when myasthenia gravis coexists with pregnancy-induced hypertension, leading to an increased threat of morbidity and mortality for both the mother and the fetus.This case report highlights the challenges associated with simultaneous occurrence of myasthenia gravis and pregnancy-induced hypertension, leading to impending eclampsia. Employing a multidisciplinary approach involving obstetricians, neurologists, anesthesiologists, and neonatologists was pivotal in addressing the complexities presented. An emergency cesarean section at the eighth month addressed worsening pre-eclampsia and respiratory distress. Strategic administration of a bolus of steroids and pyridostigmine, coupled with the use of cardiac-stable ropivacaine for spinal anesthesia, contributed to a successful procedure. Post-delivery, neonatal observation confirmed the absence of transient myasthenia gravis, with subsequent normal follow-up examinations for both mother and baby. This case underscores the need for a comprehensive approach in managing these uncommon but high-risk conditions during pregnancy.","PeriodicalId":13310,"journal":{"name":"Indian Journal of Clinical Anaesthesia","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139270842","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}