ABSTRACT
Myasthenia gravis is an autoimmune disease which causes disorder in transmission at the neuromuscular junction. In patients with myasthenia gravis undergoing surgical procedures administration of general anaesthesia becomes challenging. Overall safe general anaesthesia can be achieved through adequate preoperative assessment and optimization; vigilant intraoperative monitoring of neuromuscular transmission along with adequate dose titrations and by Train of four responses (TOF) guided administration of non depolarising muscle relaxants.
ABSTRACT
Anaesthetic management of a primigravida with chronic kidney disease, IgA Nephropathy and patent ductus arteriosus is challenging. Complications of spinal anaesthesia occurring in such patients are more challenging to treat. Safe anaesthetic management requires adequate preoperative assessment, optimization and planning
ABSTRACT
Ruptured ectopic pregnancy is a form of obstetric hemorrhage which is the world leading cause of maternal mortality. A 22 year female admitted with chief complaint of abdominal pain and 2 months of amenorrhea and diagnosed as acute on chronic ruptured ectopic pregnancy. Emergency laparotomy was planned. Proper preanaesthetic check-up was done. There were no other comorbidities; no significant past and family history were present. Intra-operatively, fluid and PCV (patient's blood group was B-ve) replacement was done according to loss. Salphingoophorectomy was done and till then patient was vitally stable but just before closure, sudden hypotension, bradycardia, hemolysis were reported. After suspected blood transfusion reaction, PCV transfusion was stopped; iv line flushed with NS, Inj. Avil, Inj. Dexona and Inj. Hydrocort, Inj. Trenexa were given. Intra operative blood sample was collected and urgent ABGA, CBC, LFT, RFT, S. LDH were sent and patient was kept in OT for 1 hour after normal vitals and then shifted to ICU intubated. Monitoring core temperature, prompt use of measures to avoid hypothermia, using blood warmers, watch for hypocalcaemia, acidosis, and hyperkalemia go a long way in unmasking blood transfusion reactions. During operation, diagnosis becomes still more difficult and uncertain, because even when present, hypotension and oozing are easily attributed to events incident to anesthesia, operation or both. Thus hemolytic transfusion reactions occurring during operation are difficult to recognize early.
ABSTRACT
A 25 year old female, known case of Turner's syndrome was posted for elective Radical Modified Mastoidectomy. Patient had tachycardia, high BP and ECG changes along with all signs and symptoms of Turner's syndrome. During surgery, the aims of anaesthetist were: 1.) To maintain hemodynamic stability, 2.) To provide optimum analgesia intraoperatively and post operatively and 3.) To maintain Peak Airway Pressure within normal limits. Patient was managed intra-operatively by monitoring vitals and maintaining airway pressures. Also airway was secured with blockbuster LMA in order to minimize haemodynamic fluctuations. Surgery was well managed and lasted for 3.5 hours. Patient was managed well intraoperatively with newer supraglottic device and all parameters were served. Patient was smoothly extubated and shifted to recovery with Aldrete score 8 out of 10. Thus, surgery was managed well both intraoperatively and postoperatively and also throughout surgery, patient remained stable. Use of LMA blockbuster was found to be useful and effective in such case for securing airway.
ABSTRACT
The population of obese individuals is increasing worldwide.Maternal obesity is an important risk factor in pregnancy and problems such as difficulty in endotracheal intubation, risk of aspiration, and hypoxia may occur 2 during generalanaesthesia.A 28-year-old woman (height 1.6 m, body weight 126 kg, BMI 49.2 kg/m ) visited GCS Hospital, Ahmedabad for selective caesarean section at a gestational age of 37 weeks. Patient was diagnosed with PIH. Spinal anaesthesia was selected because of the high possibility of endotracheal intubation failure due to super morbid obesity.Considering the possibility of hypotension, an arterial cannula was placed in the right radial artery for invasive arterial pressure monitoring. After sterile preparation, spinal anaesthesia was performed through the L3–4 interspinous space using a 90 mm 24-gauge spinal needle. During surgery,Blood pressure was maintained between 160/88 and 86/38 mm Hg and heart rate was maintained between 70 and 104 beats/min. The surgery was completed uneventfully. The block level of spinal anaesthesia was maintained at the T8 dermatome level during the operation and was also confirmed at the end of operation.
ABSTRACT
A middle aged female presented with abdominal distension due to tubo ovarian abscess compressing both ureters leading to Acute Kidney Injury and reactive pleural effusion posted for diagnostic laproscopy and laparotomy done under general anaesthesia with Rapid Sequence Induction. The aims of anaesthetist during surgery were 1) To maintain hemodynamic stability and prevent regurgitation. 2) To provide optimum analgesia intraoperatively and post operatively and 3) To maintain Peak Airway Pressure within normal limits to prevent the basal lung atelectasis. Intra-operatively hemodynamic vitals were monitored and airway pressures were maintained within normal limits. Intra operatively laryngospasm occurred that was treated with i.v. succinylcholine and regurgitated contents were suctioned immediately. Patient was uneventfully managed and underlying pathology was corrected. Post-operatively; patient was shifted to ICU with endotracheal tube in situ that was weaned off eventually and successfully. Thus finally meticulous and collaborative efforts of Anesthesiologist, Gynecologist and para-medical staff, such critical patient can be well managed pre, intra and postoperatively uneventfully.