ABSTRACT
Patients scheduled to undergo renal transplantation are often the most complex ones that an anaesthesiologist may encounter, as intraoperative hemodynamic instability can adversely affect the outcome of renal transplantation. Amlodipine is the commonly prescribed drug to patients with end stage renal disease [ESRD] for control of hypertension. Preoperative use of amlodipine may rarely present as intraoperative hypotension. Amlodipine induced hypotension is usually refractory to commonly used vasopressors. Combination of calcium, different sympathomimetic agents and fluids with minimal invasive monitoring with FloTrac/EV 1000 can be helpful in this situation. It is important to titrate antihypertensive medications in perioperative period to prevent intraoperative hemodynamic instability during renal transplantation as it can affect the graft function. We report a case of successful management of intraoperative refractory hypotension after therapeutic dose of amlodipine during renal transplantation
ABSTRACT
A specially designed wire-reinforced endotracheal tube - the Fastrach silicone tube [FTST] designed to facilitate endotracheal intubation through intubating laryngeal mask airway [ILMA] are expensive and not readily available. Hence, it is worth considering alternative such as polyvinyl chloride tracheal tube [PVCT], which is disposable, cheap and easily available. The aim of the present study was to compare the clinical performance of FTST with conventional PVCT for tracheal intubation through ILMA. After informed consent, 60 ASA I-II adults with normal airway undergoing elective surgery were randomly allocated to undergo blind tracheal intubation through ILMA with a FTST or conventional PVCT. Overall success rate, ease of insertion, number of attempts for successful intubation, critical incidence during intubation and post-operative sore throat were compared. The overall success rate with FTST was 96.63% and 93.33% with PVCT; in addition, the first attempt success rate was 86.25% with FTST compared to 82.14% with PVCT. The time taken for intubation was 18.6 +/- 6.8 s. in FTST group and 22.42 +/- 8.5 s. in PVCT group. Incidence of sore throat was 21.42% in PVCT group compared with 6.89% in FTST group. Blind tracheal intubation through an ILMA with the conventional PVCT instead of FTST is a feasible alternative in patients with normal airways.