ABSTRACT
Atrial septal defect [ASD] is the most common congenital acyanotic heart disease in adults and accounts for 10% of congenital cardiac defects in adults. It is the most commonly seen congenital cardiac lesion in women of child-bearing age and the pregnancy is usually well tolerated. Pulmonary hypertension is defined as a mean pulmonary arterial pressure greater than 25mm Hg at rest or greater than 30mm Hg during exercise. We report a case of a large ASD with mild pulmonary hypertension in a patient who underwent emergency caesarean section under general anesthesia for failure to progress. During the general anesthesia for the procedure our objectives were to avoid hypotension, hypoxemia, hypercarbia, hypothermia, reversal of shunt [Eisenmenger's syndrome] and fluid overload. The patient had an eventful perioperative course and discharged from the hospital on the 8[th] postoperative day in good physical condition
ABSTRACT
To compare the sensory and motor loss and duration of analgesia in patients undergoing lower abdominal and lower limb surgeries when isobaric ropivacaine or bupivacaine were used in spinal anesthesia. One hundred ASA grades I and II patients of either sex in the age range of 20-60 years undergoing lower abdominal and lower limb surgery were randomly divided into two equal groups: in Ropivacaine Group, patients received 22.5 mg of inj. ropivacaine for spinal analgesia and in Bupivacaine Group; 15 mg of inj. bupivacaine was used for spinal analgesia. Parameters observed were onset of sensory and motor block, two segments regression and duration of motor blockade. The sensory onset was significantly delayed in the Ropivacaine Group [42.6 +/- 11.39 min] compared to the Bupivacaine Group [18.4 +/- 6.53 min], P<0.001. The motor onset was also significantly delayed in Ropivacaine Group [55.54 +/- 13.01 min] compared to Bupivacaine Group [27.5 i 8.03 min], P<0.001. The peak sensory time was significantly delayed in the Ropivacaine Group [10.92+ 2.60 min] compared to Bupivacaine Group [7.38 + 1.69 min], P<0.001. The peak motor time was also significantly delayed in the Ropivacaine Group [8.92 +/- 2.41 min] compared to the Bupivacaine Group [4.82 +/- 1.22 min], P<0.001.The two dermatomal sensory segment regression was significantly prolonged in Ropivacaine Group [117.2 +/- 12.5 min] compared to Bupivacaine Group [108.5 +/- 10.61 min], P<0.001. The duration of motor blockade was significantly prolonged in the Bupivacaine Group [190.2 + 28.37 min] compared to the Ropivacaine Group [149.7+8.60 min], P<0.001.The duration of post-operative analgesia was similar in both the groups and was statistically insignificant. There was no significant difference in the comparison of heart rate, blood pressure nor significant respiratory side effects between the groups. The quality of sedation was better in Ropivacaine Group [1.161:0.37] as compared to Bupivacaine Group [0.96+0.49] but statistically insignificant. Intrathecal plain ropivacaine might be superior to bupivacaine in terms of a longer sensory block, and a shorter motor block duration. Therefore 0.75% isobaric ropivacaine can be safely used in lower limb and lower abdominal surgeries, especially in cases where early ambulation is desired
ABSTRACT
Pheochromocytomas are highly vascular and catecholamine producing tumours derived from sympathetic or parasympathetic nervous system, and are estimated to occur in 2-8 out of 1 million population per year; about 0.1% of all hypertensives harbour a pheochromocytoma. Patients usually present with signs and symptoms of sympathetic stimulation, e.g. tachycardia and hypertension etc. We present a rare presentation of pheochromocytoma; a patient with undiagnosed abdominal mass posted for exploratory laparotomy diagnosed to be pheochromocytoma only by histopathology postoperatively. This patient developed intraoperative hypertensive crisis and pulmonary oedema but was managed successfully with proper treatment