ABSTRACT
Oesophagus is the second most (46.8%) common site of impaction of foreign body in the gastro-intestinal tract. Dentures constitute the 3rd most common (2.4%) foreign body in oesophagus of adults, following meat bone (76.1%) and coin (3.6%).In our Institute, impacted dentures in esophageal are referred to our department after a failed endoscopic venture at removal by ENT surgeons. Extraction in such a situation calls for judicial planning and careful timing of the procedure to achieve satisfactory results. The present study was done on 11 cases of thoracic oesophageal dentures which were removed surgically in the Department of CTVS Medical College and Hospital, Kolkata over 2 years of period. Between 1st October 2017 to 30st September 2019, 11 dentures were extracted from thoracic oesophagus via right postero-lateral thoracotomy approach. The defect in the oesophagus after denture removal was primarily closed; with reinforcement using intercostals muscle pedicled flap. A defunctioning cervical oesophagostomy and a feeding jejunostomy (FJ) were done in all cases. Surgical leaks were noted in 5 cases, of which 1 lady had fulminant mediastinitis before she died. Pneumonia was observed in 4 cases, superficial surgical wound infection in 2 cases, blocked FJ tube in 1 case and leakage following closure of cervical oesophagostomy in 3 cases. Thoracic esophageal dentures are serious surgical entities which need early diagnosis and management. Pre-operative optimization is very important for avoiding surgical leakage.
ABSTRACT
Background: del Nido cardioplegia has been historically used in paediatric cardiac surgery. However it’s use in adults has also been documented. It has the advantage of 90 minutes of cardiac inactivity over St. Thomas solution no.-2, which requires repeated dosing at 20 minutes interval. Aim of this study to find out whether del Nido cardioplegia with longer duration of arrest is advantageous over St. Thomas solution no. 2 in adult mitral valve replacement.Methods: Total 60 patients of severe mixed mitral valve disease of comparable patient profiles, underwent mitral valve replacement with preservation of anterolateral and posteromedial chordae. Half the patients received del Nido cardioplegia and other half received St. Thomas solution no 2. (ST-2). The two groups were compared.Results: del Nido group had lesser CPB time (70.73±12.15min) as compared to ST-2 group (81.76±20.03min) with p=0.01 ; lesser Cross clamp time (del Nido- 68.8±10.64min; ST-2- 75.83±14.00min) with p=0.02; lesser time taken to arrest heart (del Nido- 21.58±13.37 sec; ST-2- 25.26±5.27 sec) with p=0.04 & lesser time taken for normal ECG activity to manifest after release of cross clamp (del Nido- 19.86±6.10 min; ST-2- 31.03±5.28min) with p=0.02. All other parameters did not reach statistical significance.Conclusions: del Nido cardioplegia group of patients required significantly less CPB time; Cross-clamp time; Mean time taken to arrest the heart; as well as that taken to manifest normal ECG morphology when compared to ST-2 group.
ABSTRACT
Introduction: Airway management is a crucial skill for theclinical anaesthesiologist. It is an integral part of generalanesthesia, allowing ventilation and oxygenation as wellas a mode for anesthetic gas delivery. The laryngeal maskairways(LMA) have become popular in airway managementas a missing link between facemask and tracheal tube interms of both anatomical position and degree of invasiveness.Haemodynamic stability is an important aspect to theanaesthesiologist for the benefit of the patients especiallyduring intubations, laryngeal mask insertion. Laryngoscopyand endotracheal intubation can cause striking changes inHaemodynamics as result of intense stimulation of sympatheticnervous system. The aim of this study was to evaluate thehemodynamic changes between endotracheal intubation andlaryngeal mask airway insertion.Material and Methods: This was a prospective observationalstudy on 46 patients of ASA I-II status divided into 2 groups of23 each. In the ETT (Endotracheal tube) group endotrachealintubation was done using Macintosh laryngoscope by usingportex cuffed endotracheal while in LMA (Laryngeal maskairway) group laryngeal mask airway was inserted accordingto the standard recommendation. Heart rate, Systolic, Diastolicand Mean arterial pressure and dysrhythmias were monitored.Results: The two groups were comparable in terms ofdemographic data as there were no significant differencesbetween the 2 groups in terms of age, sex, duration of surgery,ASA grades and MPC classification. Heart rate (HR), Systolicblood pressure (SBP), Diastolic blood pressure(DBP), Meanarterial pressure (MAP) remains on higher side in ETT groupthan LMA group which was statistically significant. P<0.05.Dysrhythmias were noted in 2 patients of ETT group whileLMA group did not notice any dysrhythmias.Conclusion: This study demonstrated that there is ahaemodynamic response consisting of an increase in Heartrate, SBP, DBP and MAP that comes with ETT insertion aswell as with LMA insertion. However, the response causedby ETT insertion is significantly greater than that caused byLMA insertion.