ABSTRACT
A 56-year-old man on maintenance hemodialysis was admitted to the intensive care unit with septic shock and coagulopathy. As there was a dialysis catheter in the right internal jugular vein, the left internal jugular vein was cannulated with a central venous catheter to initiate vasopressor therapy. A chest X-ray showed formation of a catheter loop inside the left brachiocephalic vein, probably due to hindrance by the dialysis catheter. This report describes the hurdles encountered, repeated cannulation attempts, and serial chest X-ray findings required to obtain acceptable placement of the catheter tip.
Subject(s)
Humans , Middle Aged , Brachiocephalic Veins , Catheterization , Catheters , Central Venous Catheters , Dialysis , Intensive Care Units , Jugular Veins , Renal Dialysis , Shock, Septic , ThoraxABSTRACT
Ropivacaine and bupivacaine were compared in various combinations for orthopedic and obstetrics patients. We have compared the clinical efficacy of two combined spinal epidural drug regimens using equal volume of 0.75% isobaric ropivacaine to 0.5% hyperbaric bupivacaine intrathecally, and 0.125% of the plain drug along with epidural opioid for elective lower abdominal surgeries. 50 patients of ASA I or II of either sex, between 18 to 60 years of age scheduled for elective surgery under combined spinal and epidural anesthesia [CSEA] were randomly allocated into two groups. Bupivacaine group [B] received 3 ml of 0.5% bupivacaine intrathecally and 0.125% bupivacaine with fentanyl 2 microg/ml epidurally while Ropivacaine group [R], received 3 ml of 0.75% ropivacaine intrathecally and 0.125% ropivacaine with fentanyl 2 microg/ml epidurally. The two groups were compared for the onset of analgesia, onset of motor blockade, duration of analgesia, time for motor recovery and the haemodynamic variables. There were no significant haemodynamic changes in both the groups. The onset of motor block was similar in both groups [4 min] but the onset of sensory block was faster with group B patients [4 min] as compared to group R [6 min]. The duration of analgesia and the time till the need for start of epidural infusion was longer in group B [221.60 +/- 10.677 min] when compared to group R [198.40 +/- 23.216 min]. However, the time for regression of motor blockade was faster in group R [172.20 +/- 10.712 min] as compared to group B [205.20 +/- 13.423 min], facilitating early ambulation of the patients. This study illustrates that both the regimens were comparable in terms of level of block, analgesia and haemodynamic stability. Intrathecal ropivacaine and epidural ropivacaine with fentanyl was shown to result in adequate level of block, complete analgesia and haemodynamic stability. The onset of analgesia however was faster in patients who received intrathecal bupivacaine
ABSTRACT
Cholecystectomy represents the second most common surgery during pregnancy. Both general and regional anesthetic techniques have been successfully used for cholecystectomy in pregnant patients. Authors present here a case of a pregnant patient carrying twin gestation who underwent cholecystectomy, which is not frequently encountered by the anesthesiologists. This report enumerates the perioperative issues relating to anesthesia given to a pregnant patient in addition to emphasizing the importance of multidisciplinary approach when such a case is encountered