ABSTRACT
Abstract Stenting for lower tracheal stenosis is a tricky situation and for the safe conduct of anesthesia, it is imperative to maintain spontaneous respiration. Airway topicalization is routinely recommended for anticipated difficult airway. We report a case of upper airway obstruction following lidocaine nebulization in a patient to be taken for tracheal stenting for lower tracheal stenosis. We would like to highlight that close monitoring of the patient is advisable during airway topicalization to detect any airway obstruction at the earliest and how fiberoptic intubation can play a pivotal role to secure the airway in an emergency scenario.
Subject(s)
Humans , Tracheal Stenosis/surgery , Airway Obstruction/etiology , Anesthesia , Airway Management , Intubation, Intratracheal , LidocaineABSTRACT
Background: Several adjuncts have been studied to potentiate the efficacy of local anaesthetic agents that increase the duration of analgesia, in peripheral nerve blocks, but the results have often been debated and counter debated. Phenylephrine has been studied intrathecally as an adjuvant and has been found to potentiate the effect of local anaesthetic agents. The present study was undertaken with a purpose to assess the efficacy of phenylephrine as an adjuvant to bupivacaine in supraclavicular brachial plexus block. Methods: A prospective, randomised, double blinded study was undertaken which included 40 ASA I or II patients, aged 18-60 years, ≥60 kg, scheduled for upper limb surgery under supraclavicular brachial plexus block. Patients were randomly divided into two groups of 20 each. Group S patients received 30 ml, 0.5% bupivacaine with 0.15 ml of saline and Group P patients received 30 ml, 0.5% bupivacaine with 0.15 ml (equivalent to 150 μg) of phenylephrine. Onset and duration of sensory and motor block, haemodynamic parameters, pain score, analgesia requirement and complications, if any, were recorded. Results: The total duration of sensory and motor block was significantly increased in group P, as compared to group S (p≤0.05). Pain scores were significantly lower and rescue analgesia demand was also significantly low in group P, in comparison to group S (p≤0.05). Demographic variables and haemodynamic parameters were comparable in both the groups. No major complications were seen. Conclusion: Phenylephrine (150 μg) when used as an adjuvant to 30 ml, 0.5% bupivacaine, in supraclavicular brachial plexus block, prolongs the duration of both the sensory and motor block thus enhances analgesia, decreases the rescue analgesic requirement and does not cause any adverse effects.
ABSTRACT
Antiphospholipid antibody (APLA) syndrome is an acquired autoimmune disorder characterized by venous or arterial thrombosis. It causes recurrent fetal losses in females of reproductive age group. However, with appropriate anticoagulant therapy in antepartum and the postpartum period, favourable pregnancy outcomes are possible. Elective caesarean sections are quite common in view of bad obstetric history. Here we discuss the anaesthetic management of a 25 year old female patient with APLA syndrome scheduled for elective caesarean section.
ABSTRACT
Background: Supraglottic airway devices (SADs) are routinely being used in Magnetic Resonance Imaging (MRI) suite but there is a lacuna in the literature regarding their in vivo comparison. The study was planned to compare two of the commonly used SADs, cLMA and i-gel in children undergoing MRI. Methods: A prospective randomized study conducted in a tertiary care teaching hospital. 50 ASA I or II children (aged 12 to 48 months) scheduled for MRI brain were included. Patients were randomly assigned to cLMA or i-gel group (25 patients in each group). We assessed a number of attempts, insertion time, oropharyngeal leak, MRI artifacts and post-procedure complications. Results: Time taken for insertion in i-gel group was significantly lower as compared to cLMA group (p=0.006). Artefacts were observed in all the patients in cLMA group and none in i-gel group, which was extremely significant statistically. Conclusion: i-gel is superior to cLMA for MRI as it does not have any ferromagnetic constituent.