An anesthetic encounter with an operated case of coarctation of aorta

Coarctation of aorta is a connective tissue disorder, which accounts for a type of acyanotic congenital heart disease. A patient with surgically treated coarctation of aorta may present in adulthood with several cardiovascular and central nervous system problems which could pose considerable challenges in their anesthetic management. We present here our experience of the anesthetic and perioperative management of an operated case of coarctation of aorta taken up for inguinal herniorraphy

Vegetable gum based gel lubrication of endotracheal tube cuffs improves efficacy of alkalinized intracuff lignocaine in preventing postoperative sore throat: a randomized controlled study

Background and aims: In order to reduce endotracheal tube [ETT] induced emergence phenomenon at extubation which involves postoperative sore throat [POST], cough, hoarseness, dysphagia and hemodynamic changes, we evaluated the efficacy of vegetable gum based [VGB] Lubic gel lubrication alone or in combination with 4% intracuff alkalinized lignocaine [IAL]. The vegetable gums in the gel appear to be of special significance

Methodology: 100 patients undergoing surgical procedures under general anesthesia were randomly allocated to 4 groups of 25 each. In Group C [control group] patients, the ETT cuffs were inflated with air and lubricated with normal saline. In Group G, the cuffs were inflated with air, while in Group L and LG, cuffs were filled with IAL. The Group G and LG cuffs were lubricated with VGB lubricant gel while Group L cuffs were lubricated with normal saline. During the post-extubation period POST was studied using Visual Analogue Scale [VAS] at 15 min, 1, 2, 3 and 24 h. Incidence of cough, dysphagia, hoarseness and hemodynamic changes was recorded and compared

Results: The mean VAS scores for POST were found to be the least in Group LG [12.6 +/- 7.08] compared to Groups C [33.8 +/- 9.38], G [32.52 +/- 2.11] and Group L [21.6 +/- 12.30] over 24 h. Incidence of cough, dysphagia, hoarseness and hemodynamic changes was least in Group LG compared to others

Conclusion: VGB gel lubrication combined with IAL enhanced the effect of IAL, than IAL or VGB gel lubrication alone thus proving most effective in preventing emergence phenomenon at extubation

Perioperative reexpansion pulmonary edema

Reexpansion pulmonary edema is a rare form of acute lung injury following rapid re inflation of collapsed lung parenchyma. It can rarely be associated with anaesthesia and repair of traumatic diaphragmatic hernia.We report a case of reexpansion pulmonary edema [REPE] occurring during repak of traumatic diaphragmatic hernia in an adult male. He was a victim of occupational trauma and presented to casualty with complaints of dyspnoea and left sided chest discomfort soon after the injury. Oxygen supplementation was administered via simple face mask to compensate for his hypoxemia. Chest radiograph revealed left diaphragmatic hernia and he was taken up for surgery. Under general anaesthesia with two lung ventilation and epidural analgesia via a thoraco-abdominal approach reduction of abdominal contents with diaphragmatic repair was undertaken. Intraoperatively within an hour of lung expansion he developed pulmonary edema. In spite of altered ventilation perfiision dynamics in the lateral decubitus position he was successfully treated on table. He recovered after a couple of days of invasive ventilatory support. Prompt diagnosis and treatment can reduce the lethality of this condition

Post-evacuation cardiopulmonary distress in a case of molar pregnancy

Molar pregnancy is a gestational trophoblastic disease wherein the swollen chorionic villi grow in a way that resembles a cluster of grapes. Patients with molar pregnancies very often need anesthesia for suction evacuation. Though molar pregnancy is usually uncomplicated, few cases may be associated with perioperative complications. Various anesthetic techniques have been used for molar evacuation. We present here a case of molar pregnancy with hyperthyroidism, in which general anesthesia [GA] was administered to the patient with laryngeal mask airway. Six hours after evacuation, she went into acute cardiopulmonary distress. She was fortunate enough to be picked up early and was managed successfully

Awake rigid bronchoscopy for post intubation tracheal stenosis

Prolonged tracheal intubation is a common cause of tracheal stenosis. These patients may present with respiratory insufficiency and stridor of insidious onset and progressive nature. Immediate management includes securing the airway which requires anesthesia. We present successful management of a case of post intubation tracheal stenosis using rigid bronchoscopy under a combination of regional and general anesthesia