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SJA-Saudi Journal of Anaesthesia. 2013; 7 (4): 461-463
in English | IMEMR | ID: emr-148646


Due to high mortality associated with aortic dissection, anesthetic management of patients with Marfan syndrome with severe aortic root dilation is a challenging situation. We describe the anesthetic management of a patient with Marfan syndrome with severe aortic root dilation, who required major surgery like cholecystectomy with partial liver resection under general anesthesia. A 47-year-old female presented to pre-anesthetic clinic for cholecystectomy with partial hepatic resection for gall bladder carcinoma. Clinical features, transthoracic echocardiography and computed tomography of thorax supported a diagnosis of Marfan syndrome with severely dilated aortic root. Aortic dissection in patients with Marfan syndrome and severely dilated aortic root can be precipitated by major hemodynamic changes under anesthesia. Careful hemodynamic monitoring and avoidance of hemodynamic swings can prevent this life-threatening event

Humans , Female , Anesthesia , Aorta/pathology , Cholecystectomy , Liver
SJA-Saudi Journal of Anaesthesia. 2013; 7 (4): 487-488
in English | IMEMR | ID: emr-148659
SJA-Saudi Journal of Anaesthesia. 2013; 7 (3): 347-349
in English | IMEMR | ID: emr-130465


Situs inversus totalis is a rare congenital condition. A 34-year-old woman with undiagnosed situs inversus was referred to our emergency department with cardiac arrested state. She underwent cardiopulmonary resuscitation [CPR] and defibrillation with a modified approach. We faced different challenging aspects during intensive care management. Ultrasonography in CPR in our patient was very helpful. We restricted our discussion on special aspect of SIT in emergency and intensive care unit

Humans , Female , Intensive Care Units , Cardiopulmonary Resuscitation , Situs Inversus/diagnosis , Emergency Service, Hospital , Electric Countershock
SJA-Saudi Journal of Anaesthesia. 2013; 7 (2): 220-222
in English | IMEMR | ID: emr-130501
SJA-Saudi Journal of Anaesthesia. 2013; 7 (2): 222-223
in English | IMEMR | ID: emr-130502
SJA-Saudi Journal of Anaesthesia. 2012; 6 (2): 140-144
in English | IMEMR | ID: emr-131523


The aim of this double-blind, prospective, randomized, controlled study was to compare the effect of addition of ketamine; fentanyl and saline with propofol anesthesia on hemodynamic profile and laryngeal mask airway [LMA] insertion conditions in oral clonidine premedicated children. 180 children [age 2 - 10 years] were at first given oral clonidine [4 microg/kg] 90 minutes before operation, and then were randomly allocated to receive either ketamine 0.5 mg/kg [n=60], fentanyl 1 micro g/kg [n=60] or 0.9% normal saline [n=60] before induction with propofol 3.0 mg/kg. Insertion of LMA was performed within 1 minute of injection of propofol. Heart rate and mean blood pressure were noted 1 min before induction [baseline], immediately after induction, before and after insertion of LMA for up to 3 min. Following LMA insertion, 6 subjective end points were noted-mouth opening, coughing, swallowing, patient's movement, laryngospasm, and ease of an insertion. LMA insertion summed score was prepared depending upon these variables. LMA insertion summed score was nearly similar in ketamine and fentanyl group, which were significantly better than saline group [P<0.004]. Mean blood pressure and heart rate were maintained in ketamine than with fentanyl or saline group. Incidence of prolonged apnea [>120 secs.] was higher in fentanyl group compared to ketamine and saline group. Even in oral clonidine premedicated children, addition of ketamine with propofol provides hemodynamic stability and comparable conditions for LMA insertion like fentanyl propofol with significantly less prolonged apnea

Humans , Male , Female , Ketamine , Fentanyl , Sodium Chloride , Propofol , Clonidine , Hemodynamics , Laryngeal Masks , Premedication , Child , Prospective Studies , Double-Blind Method