Acute kidney injury and posterior reversible encephalopathy syndromea case report

A 30 year old postpartum female presented to us with clinical features of headache, vomiting, hypertension, blurring of vision and altered sensorium. On investigating she had anemia and deranged kidney function tests. The computerised tomography [CT] scan head findings were suggestive of posterior reversible encephalopathy syndrome [PRES], which was confirmed by magnetic resonance imaging [MRI] of the brain. The patient responded to symptomatic treatment and was discharged with normal MRI of head and normal kidney function test. We would like to highlight this neuro-radiological condition, which if treated promptly, has a good outcome

Epidural anesthesia ending in an unintended subdural block: a case report

Although epidural anesthesia is routinely practiced in all of the major clinical settings, accidental subdural block still remains its poorly understood complication which haunts anesthesiologists with its variable clinical presentation. A 40 years old patient given thoracic epidural anesthesia developed an episode of hypotension along with numbness in both arms and legs with sensory block upto C6 dermatome and some motor weakness, after giving loading dose of local anesthetic solution. She was successfully managed. Hence, patients receiving epidural anesthesia should be closely observed for any such untoward complication

role of pre-operative investigations in relatively healthy general surgical patients- a retrospective study

Pre-operative testing has been criticized as having little impact on peri-operative outcomes. The aim of this study was to establish the number of unnecessary pre-operative investigations undertaken in American Society of Anesthesiologists [ASA] Grade I patients undergoing general surgery. The clinical record of 1200 patients, who underwent surgery in a period of 6 months from June 2012 to December 2012, were screened, out of which record of 500 ASA-I patients, aged 15-50 years, undergoing cholecystectomy and hernia repair were reviewed. Pre-operative investigations were assessed in terms of frequency of use and abnormalities detected. It was also checked whether the abnormal results altered the patient s management. The peri-operative complications if any were noted and their co-relation to the investigations was established. The total cost of investigations was calculated. All 100% of the patients had had preoperative tests for hemoglobin, total leucocyte count, differential leucocyte count, urine routine examination, random blood sugar and blood urea levels. Platelet count was done in 90%, serum creatinine in 50%, liver function tests in 55%, x-ray chest in 94% and electrocardiogram in 84% of the patients. No change in the plan of anesthesia was made in any of these cases. 7.5% of the patients required some intra-operative or post-operative intervention. The total cost of processing the requested investigations as per the list provided by the Central Government Health Services [CGHS] was Rs 3,62,125 or IRs. 724.25 per patient. We conclude that routine pre-operative investigations are unnecessary in ASA Grade-I patients undergoing low to moderate risk general surgery. There is a need to have guidelines for indicated tests in different groups of diseases and procedures, to be ordered by the anesthesiologists to prevent unnecessary wastage of time, money, and resources and to avoid overburdening laboratory staff

Transcutaneous electrical nerve stimulation as an adjunct to non-steroidal anti-inflammatory medications for pain management during pleurodesis

To evaluate the effectiveness of transcutaneous electrical nerve stimulation [TENS] as an adjunctive to non-steroidal anti-inflammatory drugs [NSAID] for the post-procedural pain in patients who underwent pleurodesis for pneumothorax. Sixty patients in the age group of 20-60 years, planned for pleurodesis in the operating rooms of our hospital, were divided into two groups of 30 each. Patients were alternatively assigned to one of the two groups. In Group I diclofenac sodium 75 mg in 100 ml of normal saline was started IV after the procedure, while TENS was applied for 45 minutes during this period. In Group II [control group] diclofenac sodium was started after the procedure, and an apparatus identical to TENS, but which did not deliver any electric current was applied as placebo. The blood pressure and pulse rate were noted at predefined intervals i.e. immediately after the procedure and then at 2, 4, 6 and 8 hrs after the procedure. A 0-10 visual analogue scale [VAS] was used to assess pain at regular intervals. When the VAS score was >/= 3, inj. diclofenac sodium 50 mg was repeated intramuscularly. The systolic blood pressure was comparable in both groups immediately and 2 h after the procedure but it was significantly less in Group I at 4, 6 and 8 hrs respectively [P<0.05]. The pulse rate was comparable in both groups immediately after, but decreased significantly in Group I at 2 hrs [P<0.05], 4 hrs [P<0.02], 6 hrs [P<0.02] and 8 hrs [P<0.02] after the procedure. The VAS score was comparable immediately and at 2 h in both groups [P=NS], but was significantly less in Group I at 4, 6 and 8 hrs after the procedure [P<0.001]. The dose of diclofenac sodium used in Group I was significantly less than in the Group II [P<0.02]. TENS is useful as an adjunctive to NSAIDs for pain relief in pleurodesis and it lead to reduction in subsequent requirement of NSAIDs. TENS is a valuable strategy to alleviate pain of pleurodesis with no adverse effects and with a good hemodynamic stability

Gilbert's syndrome

Gilbert's syndrome is a form of hereditary non-hemolytic jaundice transmitted by autosomal dominant pattern. Since there is low glucuronyl transferase activity in the liver there is a risk for anesthetic toxicity with a possibility of a catastrophic outcome. It is important for the anesthesiologists to understand the pathophysiology of the disease and the conditions leading to decreased glucuronyl transferase activity. We report a case of Gilbert's syndrome with hypertension, operated for cholelithiasis under thoracic epidural analgesia supplemented with transcutaneous electrical nerve stimulation in the postoperative period. Minimal administration of intravenous drugs, maintaining the organ perfusion and postoperative pain relief using epidural anesthesia offers a safe conduct of anesthesia which can be considered as an alternative to general anesthesia