Airway Management in a Child Presenting with Syngnathia for Surgical Correction

Syngnathia is a rare disorder characterized by bony fusion of maxilla and mandible which can be unilateral, or bilateral.1,2,3,4 Only 24 cases have been reported since 1936. Airway management in case of surgery for syngnathia varies from observation or sedation only, up to full airway control. It is a formidable task for anaesthetist to manage anticipated difficult intubation.Management of difficult airway is challenging task for anaesthesiologist. We present a case of 5 yr. old female with syngnathia with a bony fusion of maxilla and mandible on right side. Multidisciplinary approach is used to manage the airway with step wise anticipation of each complication. Child is premedicated with oral promethazine, nebulisation given, followed by FOB by maintaining spontaneous ventilation in the child.

Comparison of Effects of Intravenous Etomidate and Propofol during Induction of Anaesthesia for Electroconvulsive Therapy.

Electroconvulsive therapy (ECT) is a standard procedure in the modern psychiatric armamentarium. It involves, application of electric stimulus for a brief time in psychiatric patients to induce generalized seizure. ECT is utilized for treating various severe, treatment-resistant or refractory psychiatric disorders, schizophrenia and major depressive disorder (MDD). During ECT, severe disturbances can be noted in the cerebrovascular and cardiovascular system. Various anaesthetic drugs used in modified ECT can prevent these disturbances. We wanted to compare induction time, alteration of hemodynamics, seizure duration, and recovery time by using intravenous etomidate and intravenous propofol for induction of anaesthesia in modified electroconvulsive therapy.METHODSSixty patients were included in this prospective and comparative study. Patients of age group of 18–60 years of either sex, who had been posted for ECT therapy were randomly divided into two groups. Group E received Inj. Etomidate at 0.2 mg/Kg IV and Group P received Inj. Propofol 1% at 1.5 mg/Kg for induction of anaesthesia. Patients were monitored for various haemodynamic parameters such as heart rate, blood pressure at basal, after induction, and 1 min, 2 min, 3 min, 5 min, 10 min and 20 min following ECT. Induction time, seizure duration, quality of anaesthesia and recovery time from anaesthesia were also noted.RESULTSInduction of anaesthesia is faster with propofol (40.30 ± 3.65 sec) than with etomidate (48.63 ± 3.29 sec). Longer seizure duration was found with etomidate (58.90 ± 11.91 sec) induction in comparison to propofol (22.16 ± 5.48 sec) induction. Propofol group had more stable hemodynamic parameters compared to etomidate group following ECT. Propofol group (7 ± 1.43 min) achieved consciousness earlier than those of etomidate group (8.60 ± 1.16 min) following induction.CONCLUSIONSPropofol had the advantage of smooth induction, stable hemodynamic parameters, and rapid recovery as compared to etomidate. However, it was associated with shorter seizure duration. Etomidate had longer seizure duration which results in better clinical outcomes over propofol. However, it was associated with greater incidence of myoclonic jerks during induction.

Comparative Study of 0.2% Ropivacaine & 0.2% Ropivacaine with 0.5 mcg/mL Dexmedetomidine in Epidural Labour Analgesia.

Labour analgesia is the emerging technique in obstetric anaesthesia. There are various ways to provide painless labour to a mother. The best technique is epidural analgesia and providing a mother with good analgesia without a motor block is best done by ropivacaine and analgesia can be prolonged with addition of adjuvants. We wanted to compare efficacy, safety, quality of analgesia, total drug requirement, effect on the course and duration of labour, neonatal outcome, maternal satisfaction and adverse events if any, of ropivacaine 0.2% + 0.5 mcg/mL of dexmedetomidine with that of 0.2% of ropivacaine alone, for epidural labour analgesia.METHODS60 patients were divided in to 2 groups of 30 each RS and RD. RD received 8 mL of ropivacaine with 0.5 mcg/mL of dexmedetomidine while RS group received ropivacaine 8 mL with normal saline through an epidural catheter inserted at lumbar level. haemodynamic parameters were assessed along with APGAR score for neonatal status and maternal satisfaction was documented.RESULTSRopivacaine with dexmedetomidine was found to be a superior combination than plain ropivacaine in providing labour analgesia. The mean drug requirement in RD group (27.46 mL) was less than RS group (30.93 mL). Duration of labour is less in RD group (180.93±21.26 min) compared to RS group (199.49±24.63 min). Neonatal outcome and maternal satisfaction were better in RD group than RS group.CONCLUSIONSMaternal satisfaction with better analgesia was seen when dexmedetomidine was added to ropivacaine group owing to significant results in VAS scores in both the groups also duration of labour was reduced in RD group.

Neutral red staining and trypsin treatment to study viability and culture yield of Dermatophytes.

Dermatophytosis is common fungal infection of human being. To diagnose dermatophytic infections microscopic examination should be followed by culture which is essential step. Many times fungus may fail to grow on culture even after direct microscopy is positive due to non-Viability of fungus and it has been revealed that trypsinization enhances the rate of isolation of fungus on culture. Therefore, the study was undertaken with an aim to look for the viability and yield of dermatophytes on neutral red staining and trypsinization respectively.