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

Clinical relevance of peripheral blood eosinophil count in allergic bronchopulmonary aspergillosis

Currently, there is not a uniform consensus regarding the number of criteria or specific cut-off values for the variety of tests that are used to diagnose allergic bronchopulmonary aspergillosis [ABPA]. Traditionally, an eosinophil count >1000cells/microl is considered an important criterion in the diagnosis of ABPA. The goal of this study was to delineate the significance of the peripheral blood eosinophil count in the diagnosis of ABPA, and the relationship between eosinophil counts and lung function and immunological and radiological parameters. This study was a retrospective analysis of the data from ABPA patients who were managed in our chest clinic. Based on their eosinophil count, the patients were classified into the following three categories: <500, 500-1000 and >1000cells/microl. The spirometric, immunological and radiological characteristics were also assessed. We studied 108 males and 101 females with a combined mean [ +/- SD] age of 34.1 +/- 12.5years. The median [IQR] eosinophil count at diagnosis was 850 [510-1541]cells/microl, and 60% of the patients had an eosinophil count of <1000cells/microl. We found no relationship between eosinophil count and lung function using spirometry and other immunological parameters. The median eosinophil count was higher in patients with an high resolution computed tomography [HRCT] chest finding of bronchiectasis [986 vs. 620, p<0.001] vs. those without and in patients with high-attenuation mucus [1200 vs. 800, p<0.001] compared to those without high-attenuation mucus. A peripheral blood eosinophil count has limited utility in the diagnosis of ABPA, and there is no relationship between eosinophil count and lung function or other immunological parameters. The higher eosinophil count that we observed in patients with central bronchiectasis or high-attenuation mucus suggests that eosinophils are primary mediators of inflammatory activity in ABPA