FloTrac/EV1000 guided management of amlodipine induced refractory hypotension during renal transplantation

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

Evaluation of effects of porcelain firing on the marginal fit changes of porcelain­ fused-to- metal crown fabricated utilizing two different margin designs and two commercially available base metal alloys

Aim: To find the marginal fit of the porcelain fused to metal crowns by two different margin designs (shoulder and chamfer) and two commercially available base metal alloys. Material and Methods: Tooth preparation of first central incisor for porcelain-fused-to-metal crown with shoulder margin and second incisor for porcelain-fused-to-metal crown with chamfer margin was done. Wax pattern of the same was prepared. Impression of both prepared ivorine incisors was made by light body impression material and poured with pattern resin. Both the patterns were invested and casted with cobalt chromium alloy for making master dies. Two wax patterns of unprepared central incisors were fabricated, one with shoulder margin and another with chamfer margin. These patterns were then cut back to the size of the coping. Four rings were invested. In each ring ten patterns, five with shoulder margin and five with deep chamfer margin were sprued together to ensure that each group would pass through the same investing and casting procedure, followed by ceramic firing and measurement. Results: Marginal fit change or marginal discrepancy (before and after firing) between the groups was highly significant. Conclusions: Veneered crowns exhibited highly significant marginal distortion than non- veneered copings after porcelain firing. Shoulder margin is better in minimizing marginal discrepancy compared to deep chamfer margin. Marginal discrepancy is less when cerabond base metal alloy is used with shoulder margin as compared to commend base metal alloy used for shoulder margin.

comparison of conventional endotracheal tube with silicone wire-reinforced tracheal tube for intubation through intubating laryngeal mask airway

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.

Homocystinuria due to cystathionine beta synthase deficiency.

A two year-old male child presented with cutis marmorata congenita universalis, brittle hair, mild mental retardation, and finger spasms. Biochemical findings include increased levels of homocysteine in the blood-106.62 micromol/L (normal levels: 5.90-16 micromol/L). Biochemical tests such as the silver nitroprusside and nitroprusside tests were positive suggesting homocystinuria. The patient was treated with oral pyridoxine therapy for three months. The child responded well to this therapy and the muscle spasms as well as skin manifestations such as cutis marmorata subsided. The treatment is being continued; the case is reported here because of its rarity. Homocysteinuria arising due to cystathionine beta-synthase (CBS) deficiency is an autosomal recessive disorder of methionine metabolism that produces increased levels of urinary homocysteine and methionine It manifests itself in vascular, central nervous system, cutaneous, and connective tissue disturbances and phenotypically resembles Marfan's syndrome. Skin manifestations include malar flush, thin hair, and cutis reticulata / marmorata.