ABSTRACT
Neurological deficits are the rare but unacceptable complications of neuraxial blockade. We report three cases of vaginal hysterectomy performed under combined spinal epidural anesthesia [CSE] using 3 mlof 0.5% hyperbaric bupivacaine [15 mg] in subarachnoid space followed by epidural analgesia top up after wearing off of spinal anesthesia. One patient complained of unilateral paresthesia and numbness on left thigh with no motor involvement in the evening postoperatively, two patients developed bilateral paresthesia and numbness over anterior thigh and knees and motor weakness in both lower limbs on next day morning. Epidural catheter was removed immediately and treated with oral tab prednisolone and tab methylcobalamin. All patients had complete recovery and were discharged after a week. Unrecognised mechanical irritation of the nerve roots by epidural catheter is thought to be the cause. We conclude that patients with epidural catheter should be monitored and on appearance of any neurological symptoms the catheter be removed to prevent permanent neurological sequelae
Subject(s)
Middle Aged , Female , Humans , Anesthesia, Spinal , Paresthesia , Catheters , Hysterectomy , Lower ExtremityABSTRACT
Surgical tourniquets are commonly used in orthopaedic and trauma surgery, but these have their complications. Reperfusion injury following simultaneous release of bilateral tourniquets is the most likely explanation of cardiac arrest in this case. We describe an unusual complication experienced by a 40 year old, 65 kg healthy male who underwent surgery for trauma to the lower extremity [bilateral fracture tibia]. Bilateral mid-thigh tourniquets [Esmarch bandage] were applied, which were simultaneously released after 90 min. After 5 min of tourniquet release sudden severe hypotension occurred followed by cardiac arrest. Patient was immediately intubated and cardio pulmonary cerebral resuscitation [CPCR] was started. We conclude that bilateral tourniquet application can be hazardous within the safe limit of tourniquet time [<2 hours] and their simultaneous release should be avoided. Moreover, Esmarch tourniquet may generate very high uncontrolled pressures and should be avoided
ABSTRACT
Postdural puncture headache [PDPH] in children has rarely been registered, but some recent studies indicate that children may also develop headache after lumbar puncture
We report two cases of PDPH that occurred in male children aged 6 yr [20 kg] and 10 yr [25 kg] who received subarachnoid block under sedation for herniotomy using 27 G Quincke spinal needle at L4-L5 space with 0.5% hyperbaric bupivacaine at a dose of 0.3 mg/kg
They developed typical postural headache after 24 hr and 48 hr respectively
They were successfully managed with complete bed rest, forced hydration, coffee drink twice, oral analgesics; and were discharged uneventfully
We conclude that now a days spinal anesthesia is being used in children and PDPH can occur in this population which can be treated on same lines as in adults
We believe that parents need to be informed about PDPH as there is inability of children to verbalise this pain
ABSTRACT
To evaluate the morbidity and mortality associated with thoracic surgery in adult patients over a period of one year. Prospective, descriptive, clinical study. Thirty patients [24 men and 6 women], who underwent various thoracic surgeries over a period of one year [1 December 2008 to 31 December 2009], were studied. The primary outcome was discharge from the hospital within 14 days after surgery. The mean age of the patients was 28.37 +/- 14.12 yrs. The surgical procedures were as follows: 13[43%] decortications, 6[20%] thoracoplasty, 6[20%] excision of a cyst, 2[7%] segmentectomy, 2[7%] lobectomy, and 1[3%] pneumonectomy. Mean duration of surgery and anaesthesia were 134.5 +/- 44.79 min and 144.5 +/- 45.59 min respectively and most of the patients [26/30[87%]] were extuabted in the operating room. Twenty [68.97%] patients were discharged from the hospital 14 days. Factors associated with prolonged hospital length of stay [>14 days] included: long duration of smoking, low FEV1, metabolic acidosis; higher intraoperative blood loss and longer duration of surgery. We conclude that patients having above risk factors should be aggressively managed and monitored intra and postoperatively
ABSTRACT
Cardiopulmonary dysfunction has been observed after the removal of benign hydatidiform mole which can lead to substantial morbidity and mortality. We report a 20 year old woman who came to casualty with a gush of per vaginal bleeding; associated findings were hypotension, anemia and tachypnoea. Evacuation of the mole was done under general anesthesia as an emergency procedure. Immediately after evacuation she developed acute massive pulmonary edema that progressed to adult respiratory distress syndrome. In spite of extensive peri-operative management in the form of vasopressors and ventilatory support, mortality occurred after 12 hours post operatively
ABSTRACT
We present a case report of 13 years old male child undergoing septorhinoplasty under general anesthesia, who developed acute massive pulmonary edema following intranasal infiltration of 330 micrograms of inj. adrenaline by the ENT surgeon. Echocardiography showed local wall hypokinesia with ejection fraction [EF] reduced to 20% and raised troponin-T levels [10 times of normal] suggesting it was adrenaline induced acute myocardial infarction and subsequent cardiogenic pulmonary edema. The surgery was postponed and the patient was successfully treated in ICU with positive pressure ventilation, frusemide and ionotropic support. His EF returned to 50% at 5hr and to 70% at 10 hr; and he was extubated after 14 hours and discharged after 5 days
ABSTRACT
Hypertension is one of the most common chronic illnesses encountered in the perioperative period. Therefore, the preoperative assessment of hypertensive patient is both a common and an important problem for the anesthesiologists, because of the deleterious and predictable effects of hypertension on cardiovascular, renal and cerebrovascujar function, individuals with untreated hypertension have significant perioperative morbidity. This article presents an overview on the current literature regarding the hypertensive patients and a simple graphic strategy for the perioperative management of hypertension and its impact on perioperative outcome