The risks associated with erector spinae plane block in patients with abnormalities of coagulation / 대한마취과학회지

No abstract available.

Bilateral transnasal sphenopalatine block for treating postdural puncture headache / 대한마취과학회지

No abstract available.

Efficacy of bilateral greater occipital nerve block in postdural puncture headache: a narrative review

The Epidural blood patch is considered the gold standard for managing postdural puncture headache when supportive measures fail. However, it is a procedure which can lead to another inadvertent dural puncture. Other potential adverse events that could occur during a blood patch are meningitis, neurological deficits, and unconsciousness. The bilateral greater occipital nerve block has been used for treating chronic headaches in patients with PDPH with a single injection. This minimally invasive, simple procedure can be considered for patients early, along with other supportive treatment, and an epidural blood patch can be avoided.

Sphenopalatine ganglion block for relieving postdural puncture headache: technique and mechanism of action of block with a narrative review of efficacy

The sphenopalatine ganglion (SPG) is a parasympathetic ganglion, located in the pterygopalatine fossa. The SPG block has been used for a long time for treating headaches of varying etiologies. For anesthesiologists, treating postdural puncture headaches (PDPH) has always been challenging. The epidural block patch (EBP) was the only option until researchers explored the role of the SPG block as a relatively simple and effective way to treat PDPH. Also, since the existing evidence proving the efficacy of the SPG block in PDPH is scarce, the block cannot be offered to all patients. EBP can be still considered if an SPG block is not able to alleviate pain due to PDPH.

Postoperative rate induced left bundle branch block after craniotomy

Rate induced left bundle branch block [LBBB] is a rare peri-operative phenomenon. We encountered rate related LBBB in a 72 year old patient who had undergone a craniotomy. Acute coronary event was ruled out by doing serial troponin-I levels and absence of new onset regional wall motion abnormalities on echocardiogram. The electrocardiographic changes reverted to normal after controlling the rate with beta blockers. Further cardiac evaluation was advised but the patient and family opted for a conservative medical management considering his age and co-morbidities

Management of opioid induced postoperative ileus: the current scenario

Persistent postoperative ileus causes significant discomfort to a surgical patient. Not only it increases hospital stay or leads to rehospitalization, it involves significant cost of treatment and morbidity in some unfortunate patients. No single intervention, drug or perioperative protocol has been found to be successful. The strategy has to be multimodal. Early enteral feeds, active ambulation, physiotherapy, use of minimally invasive surgical techniques so as to reduce bowel handling, judicious use of narcotics, good perioperative pain relief using a multimodal approach are the strategies that when applied together has better outcomes. Peripherally acting opioid antagonists have been successfully used but are very costly. Perioperative intravenous lidocaine infusion along with other strategies appears promising

study to evaluate the influence of shoulder position on central venous catheter tip location during infraclavicular subclavian approach

Background and Objective: Subclavian vein [SV] catheterization via infraclavicular approach is routinely done for multiple uses in operating rooms as well as in intensive care units in selected patients. The aim of this study was to evaluate the influence of shoulder position on central venous catheter [CVC] tip location during infraclavicular subclavian approach

Methodology: A prospective observational study was conducted on 60 patients and included American Society of Anesthesiologist [ASA] physical status 1 and 2 patients in whom CVC was planned. Catheters were introduced either in neutral shoulder position or the shoulder was lowered during venipuncture and guide wire insertion. A post-operative chest X-ray was done to note any complications and catheter tip malposition

Results: Demographic data was comparable between the two groups with respect to age, gender and weight. [P > 0.05]. In one case in Group A and two cases in Group B there was failure to puncture the vein but this was statistically insignificant [P = 0.554]. Failure to thread the guidewire was seen in one case in each group with no statistical significance [P > 0.05] Statistical difference was noted in successful placement of CVC tip between the two shoulder position [P = 0.025]

Conclusion: The neutral shoulder position reduced the incidence of catheter misplacements during infraclavicular approach of right subclavian vein catheterization as compared to lowered shoulder position

Ultrasound Guided Transversus Abdominis Plane Block for Anterior Cutaneous Nerve Entrapment Syndrome

Anterior cutaneous nerve entrapment syndrome (ACNES) is one the most common cause of chronic abdominal wall pain. The syndrome is mostly misdiagnosed, treated wrongly and inadequately. If diagnosed correctly by history, examination and a positive carnett test, the suffering of the patient can be relieved by addressing the cause i.e. local anaesthetic with steroid injection at the entrapment site. Conventionally, the injection is done by landmark technique. In this report, we have described 2 patients who were diagnosed with ACNES who were offered ultrasound guided transverses abdominis plane (TAP) injection who got significant pain relief for a long duration of time.

brief review of septic cardiomyopathy and possible preventive strategies

Sepsis induced cardiomyopathy leads to significant morbidity and mortality if not identified early and treated judiciously. A lot is written and discussed about it but till date, the syndrome remains a dilemma. Clinicians have used various modalities like beta- blockers to reduce heart rate, polymyxin B hemofiltration to neutralize the endotoxinemia thereby interfering with the progression of myocardial dysfunction, statins for its anti - inflammatory, antithrombotic and antioxidative properties thereby causing myocardial protection in the same way as it does in coronary artery disease. Ivabradine is a novel drug which is the first If current inhibitor that causes selective heart rate reduction without any antihypertensive effect like beta blockers and doesn't affect hemodynamics. Its still in the trial stage. At present the only effective measure seems to be intensive fluid therapy, aggressive source control and use of broad spectrum antibiotics and maintenance of optimum hemodynamics with vasoactive agents

Fat embolism syndrome due to bilateral intramedullary nailing of tibia

Fat embolism syndrome is commonly encountered after long bone and hip fractures. Postoperatively it may be encountered after intramedullary nailing of long bones and pelvicarthropksties. We report a case involving a 17 year old girl who had both tibial bone fractures and underwent intramedullary nailing with vascular repair and developed fat embolism with lung infiltrates requiring non-invasive ventilation. We also review relevant literature and describe criteria required to diagnose fat embolism syndrome

Benefits of using dexmedetomidine during carotid endarterectomy: a review

As per current recommendation, patients with acute ischemic stroke should be offered carotid endarterectomy [CEA] within 24-72 hours. The same applies to patients with recurrent transient ischemic attacks [TIA]. This time is usually less for hemodynamic optimization of patients who've suffered acute ischemic stroke. Hence' they are hemodynamically labile and can have accelerated hypertension on induction/extubation. This can have disastrous outcomes. It is a common practice among anesthesiologists to avoid angiotensin converting enzyme[ACE] inhibitors or angiotensin receptor blockers on the day of surgery. This also adds to hypertensive issues perioperatively. Dexmedetomidine is a wonderful drug which can be used during CEA. Due to its centrally mediated sympatholytic effect, it confers good hemodynamic control during induction, intraoperatively, and during extubation. We did a search on PubMed and Google for carotid endarterectomies done under general and locoregional anesthesia during which dexmedetomidine was used. The keywords used by us during the search were as follows: anesthesia, carotid endarterectomy, anesthesia. We also searched for use of dexmedetomidine infusion to attenuate hypertensive response to intubation and for providing stability in major surgeries like CABG, craniotomies, bariatric surgeries, and valve replacements.

Dexmedetomidine in pulmonary hypertension: a Review

Patients with pulmonary hypertension often have adverse outcomes after anesthesia. Tachycardia, hypertension, hypervolemia, increased intrathoracic pressure, acidosis, painful stimuli and hyperthermia are triggering factors for adverse perioperative events. Dexmedetomidine is a centrally acting alpha agonist which, due to its desirable properties like sympatholysis, bradycardia and micro agonism, can be a useful agent for patients with pulmonary hypertension. Dexmedetomidine also has the ability to potentiate inhalational, intravenous and regional anesthetics when it is used as an adjunct