Failed ventilation with LMA Proseal [registered sign] in a patient with sleep apnea syndrome

Patients with sleep apnea syndrome [SAS] have excessive adipose tissue in oropharynx which can obstruct the airway. A high prevalence of difficult intubation has been reported in these patients and an association between the severity of SAS and difficult intubation has been suggested. LMA Proseal[registered sign] [LMA Company, USA] has been launched as a better alternative to LMA classic, as it provides good airway seal due to its modified cuff. The improved seal of LMA Proseal[registered sign] [PLMA[registered sign]] has an advantage in obese patients where higher airway pressures are required for positive pressure ventilation. We found that LMA Classic[registered sign] provided better airway management than PLMA[registered sign] in one of our obese patients with SAS

Evaluation of interadductor approach in neurolytic blockade of obturator nerve in spastic patients

Spasticity is a syndrome associated with a persistent increase in involuntary reflex activity of a muscle in response to stretch. Adductor muscle spasticity is a common complication of spinal cord and brain injury. It needs to be treated if it interferes with activities of daily living and self-care. Obturator neurolytic blockade is one of the cost-effective therapeutic possibilities to treat spasticity of adductor group of muscles. In this study, we assessed the efficacy of interadductor approach in alleviating the spasticity. Obturator neurolysis using 8-10 ml 6% phenol was given with the guidance of a peripheral nerve stimulator in 20 spastic patients. Technical evaluation included number of attempted needle insertions, time to accurate location of the nerve, depth of needle insertion, and success rate. Pain, spasticity, hip abduction range of motion [ROM], number of spasms, gait, and hygiene were evaluated at 1[st] hour, 24[th] hour, end of the 1[st] week, and in the 1[st], 2[nd], and 3[rd] months following the intervention. The success rate was 100% with mean time to accurate nerve location 4.9 +/- 2.06 min. Average depth of needle insertion was 2.91 +/- 0.32 cm. Compared with the scores measured immediately before the block, all studied parameters improved significantly. An increase in the Modified Ashworth Scale values was observed in the 2[nd] and 3[rd] months, but they did not reach their initial values. The interadductor approach proved to be accurate and fast, with a high success rate. Phenol blockade is an efficient and cost-effective technique in patients with adductor spasticity. It led to a decrease in spasticity and pain with an increase in the ROM of the hip and better hygiene, with an efficacy lasting for about 3 months

Spasticity - pathogenesis, prevention and treatment strategies

This review of the long-term management of spasticity addresses some of the clinical dilemmas in the management of patients with chronic disability. It is important for clinicians to have clear objectives in patient treatment and the available treatment strategies. The review reiterates the role of physical treatment in the management, and thereafter the maintenance of patients with spasticity. Spasticity is a physiological consequence of an injury to the nervous system. It is a complex problem which can cause profound disability, alone or in combination with the other features of an upper motor neuron syndrome, and can give rise to significant difficulties in the process of rehabilitation. This can be associated with profound restriction to activity and participation due to pain, weakness, and contractures. Optimum management is dependent on an understanding of its underlying physiology, an awareness of its natural history, an appreciation of the impact on the patient, and a comprehensive approach to minimizing that impact. The aim of this article is to highlight the importance, basic approach, and management options available to the general practitioner in such a complex condition

effect of pregabalin and gabapentin on preoperative anxiety and sedation: a double blind study

Pregabalin and gabapentin are compounds, which have been alleged to possess anxiolytic, analgesic, and anticonvulsant properties. Both are amino acid derivatives of gamma amino butyric acid. Pregabalin has a similar pharmacological profile to that of gabapentin. It has an amino acid substitution at third position which allows better lipid solubility and diffusion across blood brain barrier, better pharmacokinetic properties and fewer drug interactions due to absence of hepatic metabolism. We hypothesized that premedication with oral pregabalin and gabapentin would produce dose-related reductions in acute [state] anxiety and increase in sedation [sleepiness] before induction of general anaesthesia. 90 women were randomly assigned to receive 300 mg pregabalin and 900 mg gabapentin and placebo 60 minutes prior to surgery. Anxiety and sedation was assessed before administration of drug and 1 hour later. A uniform anaesthetic technique was used in all groups. Parameters including sedation scores and various side effects were assessed. Demographic variables were comparable. The preinduction anxiety scores were statistically significant from the baseline values in group 1 and 11. The sedation scores were statistically significant 1 hour after the drug. There was statistically significant difference between group I and II [p=0.000], I and III [p=0.000] and II and III[p=0.015]. Analysis of sedation scores after surgery were comparable at all time intervals between group I and II. However statistically significant difference was noted between group I and III [p=0.000] and group II and III [p=0.000]. A higher percentage of patients in the pregabalin group complained of dizziness and somnolence than the gabapentin and control group. Preoperative pregabalin [300mg] and gabapentin [900mg] administration 1 hour before surgery led to significant reduction in preoperative anxiety and improves sedation without producing significant side effects

Massive subcutaneous emphysema secondary to rigid bronchoscopy in a child

Massive subcutaneous emphysema is a rare complication of interventional bronchoscopy. Complications reported include laryngeal and bronchial spasm, hematorrhea, arrhythmia, airway obstruction, tracheoesophageal fistula, and pneumothorax. Massive subcutaneous emphysema is a rare complication of rigid bronchoscopy. There has been no case report mentioned in the literature till date to the best of our knowledge. We report an eighteen months old female child who developed emphysema involving upper third of her chest, neck and face after rigid bronchoscopy, which increased progressively threatening closure of the airways but was successfully managed conservatively. The details of this case and the management are discussed

Obturator neurolysis using 65% alcohol for adductor muscle spasticity

Spasticity is motor alteration characterized by muscle hypertonia and hyperreflexia. It is an important complication of spinal cord injury, traumatic brain injury, cerebral palsy, and multiple sclerosis. If uncorrected, fibrosis and eventually bony deformity lock the joint into a fixed contracture. Chemical neurolysis using various agents is one of the therapeutic possibilities to alleviate spasticity. We are, hereby, reporting 3 patients in whom 65% alcohol was used as neurolytic agent for the treatment of hip adductor spasticity, and the effect lasted for a variable period

randomized controlled trial to compare pregabalin with gabapentin for postoperative pain in abdominal hysterectomy

Pregabalin is a potent ligand for alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system, which exhibits potent anticonvulsant, analgesic and anxiolytic activity. The pharmacological activity of pregabalin is similar to that of gabapentin and shows possible advantages. Although it shows analgesic efficacy against neuropathic pain, very limited evidence supports its postoperative analgesic efficacy. We investigated its analgesic efficacy in patients experiencing acute pain after abdominal hysterectomy and compared it with gabapentin and placebo. A randomized, double-blind, placebo-controlled study was conducted in 90 women undergoing abdominal hysterectomy who were anaesthetized in a standardized fashion. Patients received 300 mg pregabalin, 900 mg gabapentin or placebo, 1-2 hours prior to surgery. Postoperative analgesia was administered at visual analogue scale [VAS] >/= 3. The primary outcome was analgesic consumption over 24 hours and patients were followed for pain scores, time to rescue analgesia and side effects as secondary outcomes. The diclofenac consumption was statistically significant between pregabalin and control groups, and gabapentin and control groups; however, pregabalin and gabapentin groups were comparable. Moreover, the consumption of tramadol was statistically significant among all the groups. Patients in pregabalin and gabapentin groups had lower pain scores in the initial hour of recovery. However, pain scores were subsequently similar in all the groups. Time to first request for analgesia was longer in pregabalin group followed by gabapentin and control groups. A single dose of 300 mg pregabalin given 1-2 hours prior to surgery is superior to 900 mg gabapentin and placebo after abdominal hysterectomy. Both the drugs are better than placebo

Co-existence of transient neurological symptoms along with post dural puncture headache [PDPH]: a case report

Regional anaesthesia is well known for complications. Major neurological sequelae after central blockade although rare but can be devastating for the patient and the anaesthetist. Coexistence of transient neurological manifestations along with post dural puncture headache has not been reported in literature. A case with the features of both is presented, although the exact cause for the coexistence could not he ascertained. Also, this patient did not respond to the usual doses of ACTH

Subglottic foreign bodies - two case reports

Subglottic foreign bodies are not uncommon. Foreign bodies in respiratory tract have been major cause of morbidity The spectrum of presentation varies widely from sudden death due to complete respiratory obstruction to accidental finding during routine investigation. Two cases of unusual subglottic foreign bodies are reported, who required emergency tracheostomy. A common problem encountered in a case of laryngeal foreign body is delayed diagnosis; and special care has to be taken not to damage the surrounding laryngeal tissues during removal

Laryngeal cyst aspiration- an aid to improve glottic view

Large laryngeal cyst is a rare, benign lesion of the larynx and may cause difficulty in tracheal intubation. Laryngoscopy in these cases can provoke a sudden increase in size due to bleeding or oedema formation and cause severe respiratory obstruction. Due to compression by the mass on the larynx, airway problems are frequent. Stridor and sudden airway obstruction can occur due to large cysts and may necessitate urgent securing of the airway. A case of a laryngeal cyst is reported which occupied right side of larynx leading to obscured indirect laryngoscopic findings and external needle aspiration improved glottic view. Another advantage was avoidance of tracheostomy and more invasive fibreoptic intubation