Karnataka Anaesthesia Journal最新文献

{"title":"Perils with laparoscopic surgery for median arcuate ligament syndrome","authors":"N. Saraswat, A. Sharma, Mohandeep Kaur, Swapna Charie","doi":"10.4103/KAJ.KAJ_29_17","DOIUrl":"https://doi.org/10.4103/KAJ.KAJ_29_17","url":null,"abstract":"A 64 years, ASA 1 male patient with median arcuate ligament syndrome was posted for laparoscopic release of coeliac artery compression. The median arcuate ligament is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus. The ligament usually passes superior to the origin of the celiac artery near the first lumbar vertebra. . Infrequently, when this union occurs anterior to celiac axis it may cause hemodynamically significant stenosis compressing the vessel and nerves leading to median arcute ligament (MALS).The surgery of median arcuate ligament release for coeliac artery decompression involved working in the proximity of major vessels. Anticipation of major blood loss should be kept in mind that may be may be further compounded by the disease process in the vessels which make repair of vessels more difficult.Iatrogenic aortic injury happened in our case which was succesfully managed. Timely involvement of cardiovascular surgeons is important therefore the case has to be discussed with them prior proceeding for surgery. Hypothermia, hemorrhagic shock, coagulopathy, hypoxia, acidosis,pre-renal failure can be prevented with thorough preparation and timely intervention.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80025402","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 intraoperative atrioventricular tachyarrhythmia in a postpartum patient posted for laparotomy","authors":"S. Govindswamy, M. Vanneru","doi":"10.4103/kaj.kaj_24_17","DOIUrl":"https://doi.org/10.4103/kaj.kaj_24_17","url":null,"abstract":"Supraventricular tachycardia is the most common sustained arrhythmia presenting in pregnancy. The increase in frequency of arrhythmias and in symptoms during pregnancy may be a result of associated hemodynamic, hormonal, autonomic, and emotional changes. A 21-year-old, post-partum patient on the 5th postoperative day was posted for laparotomy in view of pelvic abscess. Surgery was started, and after opening the abdomen, 1–1.5 L pus was drained and a lot of adhesions were noted in pelvic region. Intestinal adhesiolysis and thorough peritoneal wash were performed. In intraoperative period, suddenly, patient's heart rate was increased to 233 bpm and blood pressure dropped to 80/60 mmHg. Resuscitated with fluids, blood and drugs like phenylephrine to imporve blood pressure. Inspite of these resuscitative efforts heart rate was fixed at 233/min with blood presure improved to 110/80mmhg. A cardiologist opinion was taken and they diagnosed it as atrioventricular reentrant tachycardia and advised injection adenosine 6 mg intravenous (IV). After adenosine IV bolus, heart rate dropped transiently up to 60 bpm and later stabilized at preoperative basal heart rate of 132 bpm with blood pressure of 128/80 mmHg. The most important aspect in treating tachyarrhythmia patients is the use of a multidisciplinary approach. The decision of what therapy to use must be addressed on a case-by-case basis with special attention to the patient's individual issues and concerns.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83839002","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":"Perioperative management of a patient with systemic lupus erythematosus with hypothyroidism posted for medical termination of pregnancy","authors":"C. Navyasri, C. Sanikop, Shreedevi Yenni","doi":"10.4103/KAJ.KAJ_26_17","DOIUrl":"https://doi.org/10.4103/KAJ.KAJ_26_17","url":null,"abstract":"Systemic lupus erythematosus (SLE) is an autoimmune disease and more frequent found in women between the age group of 15 to 45years . disease will coexcist with pregnancy. Disease exacerbation, increased foetal loss, neonenatal lupus and an increased incidence of pre-eclampsia are the major challenges. Its multisystem involvement and therapeutic interventions like anticoagulants, steroids and immunosuppressive agents pose a high risk for both surgery and anaesthesia. We describe successful management of an women with SLE with ten weeks whois posted for medical termination of pregnancy.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77076837","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":"High-Risk consent in anesthesia: The need of the hour","authors":"Ramyavel Thangavelu","doi":"10.4103/kaj.kaj_9_18","DOIUrl":"https://doi.org/10.4103/kaj.kaj_9_18","url":null,"abstract":"","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75244869","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":"Evaluation of transversus abdominis plane block for postoperative analgesia after lower segment cesarean section","authors":"S. Naveen, R. Singh, P. Sharma, Sirisha Anne","doi":"10.4103/kaj.kaj_7_18","DOIUrl":"https://doi.org/10.4103/kaj.kaj_7_18","url":null,"abstract":"Background: Lower segment cesarean section (LSCS) is a common surgery in young women. There is a need for good postoperative analgesia in these cases as these patients are new mothers who need to nurse their newborns and there is a very important aspect of mother and child bonding for which they need to remain pain free and alert. For this, we need to rely on techniques which are not dependent on opioids and are equally effective. Transversus abdominis plane (TAP) block is one such technique which seems to fit the bill. This study was undertaken to evaluate the effectiveness of TAP block as a postoperative analgesia technique in these cases and its usefulness in reducing postoperative opioid consumption. Methods: One hundred and forty patients were selected prospectively who were to undergo LSCS. They were randomly divided into two groups: CONT and TAP. CONT group received subarachnoid block (SAB) with hyperbaric bupivacaine, and TAP group received similar SAB and immediately after surgery was given TAP block under ultrasound guidance with 20 ml of 0.25% bupivacaine with 4 mg dexamethasone on each side. Pain score was monitored in the postoperative period, every hour for 4 h and 2 hourly for next 4 h and then at 12, 18, 24, 36, and 48 h with visual analog scale of the scale 0 to 10. They all received intravenous paracetamol 1000 mg 8 hourly. If the pain score crossed four, they were given intramuscular (IM) diclofenac sodium 75 mg and if pain score persisted above four after an hour, they were given IM pethidine 50 mg. The time to requirement/demand of rescue analgesia was noted and a total amount of opioids given were noted. Results: The mean time to first analgesic rescue was significantly prolonged in Group TAP as compared to Group CONT using unpaired t-test. Mean time to rescue analgesia was 88.02 ± 21.62 min and 525.27 ± 114.52 min (P < 0.001) in groups CONT and TAP, respectively. Opioid consumption in Groups TAP and CONT was 14.29 mg versus 166.95 mg (P < 0.001) in 48 h. Conclusion: TAP block is a very effective modality for postoperative pain relief after LSCS. It helps in reducing opioid consumption and is likely to keep them more alert.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91539708","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 confound revelation of physical incompatibility between heparin sodium and atracurium besylate","authors":"Tuhin Mistry, Ankita Chaki","doi":"10.4103/KAJ.KAJ_4_18","DOIUrl":"https://doi.org/10.4103/KAJ.KAJ_4_18","url":null,"abstract":"","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89591559","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":"Rheumatoid arthritis with fracture femur managed with three-in-one femoral nerve block","authors":"K. Vasantha Kumar, T. Kauser, A. Prabhu, Harish Pachaiyappan","doi":"10.4103/kaj.kaj_10_17","DOIUrl":"https://doi.org/10.4103/kaj.kaj_10_17","url":null,"abstract":"Rheumatoid arthritis (RA) can be defined as chronic polyarthritis affecting mainly the peripheral joints, running a long course with exacerbations and remissions, and also accompanied by a generalized systemic disturbance. Anesthetic risks in osteoarticular disorders involve not only the mechanical deformities caused by the diseases but also their cardiovascular, respiratory, renal, and digestive systemic effects. Whenever possible, surgery should be performed under regional anesthesia, the advantages of which include avoidance of airway manipulation and polypharmacy related to general anesthesia. The “3-in-1 block” entails injection of large volume of local anesthetic around the femoral nerve with resultant blockade of the obturator, femoral, and lateral cutaneous nerves of the thigh. Here, we report a case of fracture neck of femur with coexisting RA and hypertensive disorder managed with three-in-one femoral nerve block.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81585134","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 child with Crouzon's syndrome and ventricular septal defect posted for ventriculoperitoneal shunt surgery","authors":"Aastha Srivastava, P. Jindal, Y. Payal, S. Malhotra","doi":"10.4103/KAJ.KAJ_15_17","DOIUrl":"https://doi.org/10.4103/KAJ.KAJ_15_17","url":null,"abstract":"Quite often in our anaesthesia practice, we encounter syndromic children presenting to us for surgery either for correction of the primary deformity or for a secondary problem. A child with a craniofacial syndrome presents with a number of issues for the anaesthetist, with difficult airway being one of the most important one. The challenge increases with increasing complexity of the surgery. When pre-anaesthetic evaluation of such a child is done, other congenital anomalies also might come into picture. These may include various types of congenital malformations or congenital heart diseases which may be diagnosed incidentally while evaluation. Anaesthetic management of such a child presenting for surgery includes a thorough pre-anaesthetic evaluation, formulating a plan for intraoperative anaesthetic management and proper postoperative care. This case report describes a child with Crouzon's syndrome posted for ventriculoperitoneal shunt surgery.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78635796","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":"Management of submandibular abscess with limited resources","authors":"J. Sharma, Amiya Ranjan Patnaik, Neerja Banerjee, R. Sood","doi":"10.4103/KAJ.KAJ_20_17","DOIUrl":"https://doi.org/10.4103/KAJ.KAJ_20_17","url":null,"abstract":"Though incidence of submandibular abscess is decreasing, from an anaesthesiologist point of view, it is invaluable to understand the disease process as the greatest impact is on the airway and failure of management can lead to catastrophic outcome. Successful management of submandibular abscess requires an accurate diagnosis, understanding the anatomy and spread of infection in the head and neck, airway control, appropriate antibiotic therapy and surgical drainage whenever needed. As an anaesthesiologist to be challenged with a submandibular abscess may not be infrequent particularly in a developing country like India, where dental and oropharyngeal hygiene can be of grave concern. The standardised approach of successful anaesthetic management of submandibular abscess usually involves an awake nasal intubation. But this may not be possible in some situations like an uncooperative patient, an acute emergency with limited resources where fibre optic bronchoscope is unavailable. We describe the successful management of one such case.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76052730","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":"I-Gel versus proseal laryngeal mask airway: A comparison between two supraglottic airway devices in elective laparoscopic cholecystectomy patients","authors":"Gian Chauhan, K. Syal, Varun Prasad, R. Verma","doi":"10.4103/kaj.kaj_25_17","DOIUrl":"https://doi.org/10.4103/kaj.kaj_25_17","url":null,"abstract":"Introduction: Although tracheal intubation is considered ideal for airway management in laparoscopic surgeries, as it provides adequate ventilation and protects against pulmonary aspiration even in the presence of raised airway pressure due to carboperitoneum, supraglottic airway devices are beginning to be used more commonly in the same scenario in the right subset of patients. Materials and Methods: Eighty American Society of Anesthesiologists I and II patients coming for laparoscopic cholecystectomy surgeries were divided into two groups of I-gel and proseal laryngeal mask airway (PLMA) each. Ease of device insertion, time of device insertion, number of insertion attempts, airway leak pressure, and ease of insertion of gastric tube was observed. Patient was inspected for any “injury” of the lips, teeth or tongue, and the device for blood stain. 18–24 h after surgery, patients were interviewed for any “postoperative complications” such as sore throat, dysphagia, and hoarseness. Results: Both I-gel and PLMA can be used safely for laparoscopic cholecystectomy; ProSeal provides better sealing pressure while I-gel is easier to use practically and has less hemodynamic variations.","PeriodicalId":17751,"journal":{"name":"Karnataka Anaesthesia Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88159322","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}