Diagnosis of cardiac tamponade with transesophageal echocardiography following the induction of anesthesia for suspected testicular torsion.

Transesophageal echocardiography (TEE) is a valuable tool for evaluating hemodynamic instability in patients under general anesthesia. We present the case of a 28‑year‑old man who presented with complaints of testicular pain concerning for testicular torsion. After induction of general anesthesia for scrotal exploration and possible orchiopexy, the patient developed severe and persistent hypotension. Using intraoperative TEE, the diagnosis of pericardial tamponade was made, and an emergent pericardial window was performed.

Efficacy of pethidine and buprenorphine for prevention and treatment of postanesthetic shivering

Postanesthetic shivering is a distressing postoperative complication. Pharmacological control is an effective method for treatment and prevention of postoperative shivering. Pethidine prevents or manages shivering far better than equianalgesic doses of other opioids. However, buprenorphine is an opioid with a similar structure to morphine but approximately 33 times more potent. This study aimed to assess and compare the effects of these two opioids in preventing post-anesthetic shivering. This randomized double- blind clinical trial was designed to compare the efficacy of buprenorphine and pethidine in prevention of post anesthetic shivering. Sixty ASA grade I-II patients undergoing general anesthesia for elective Cesarean section entered the study. Patients received either buprenorphine 3microg/kg [n=30] or pethidine 0.5 mg/kg [n=30] intravenously 30 min before the end of surgery. Heart rate and blood pressure were measured 15 min after the injection. Occurrence of shivering was evaluated for one hour in the recovery room. Also, pain intensity was assessed by using a visual analog scale [VAS; 0-5]. Shivering was significantly reduced in the pethidine group [5 of 30 versus 13 of 30, p < 0.05]. Visual pain scores were similar in both groups. There was no difference between the two groups regarding hemodynamics. Despite similar in pain control, pethidine is more effective than buprenorphine in prevention of post anesthetic shivering

Anaesthetic challenges in surgical excision of phaeochromocytoma

Background: Phaeochromocytoma is a rare tumour; which is benign but metabolically active; with a potential for malignancy. This tumour of adrenal or extra adrenal origin usually presents as hypertension; which can be sustained or paroxysmal and with lethal complications. Aim: To present an anaesthetic experience during the surgical resection of a phaeochromocytoma. Method: A 26-year old woman with phaeochromocytoma of the right adrenal gland is presented. The tumour was excised under general anaesthesia. The anaesthesia involved the use of continuous infusion of esmolol (an ultra short-acting intravenous cardioselective beta-antagonist) and propofol. The resected tumour was sent for histopathological examination. Results: The tumour was completely excised under general anaesthesia. The haemodynamic changes that occurred during tumour handling were controlled with fentany1;propofol/esmolol infusion. Histopathological findings confirmed phaeochromocytoma. Conclusion: Although; the anaesthetic and surgical management of a phaeochromocytoma could be an uphill task; it is possible in an environment with limit laboratory and intensive care facilities

Pharyngolaryngeal discomfort after use of LMA among patients receiving intermittent positive pressure ventilation and that breathing spontaneously

To evaluate the occurrence of postoperative sore throat after the use of LMA among patients undergoing surgery on intermittent positive pressure ventilation and those on spontaneous mode. hundred adult patients of ASA I or II status were included and divided into two equal groups. Group I patients were randomly assigned for positive pressure ventilation and group II patients for spontaneous breathing. Anaesthesia was administered with propofol, oxygen nitrous oxide and halothane. The LMA of appropriate size was placed.After completion of surgery, LMA was removed when the patient regained deglutition reflex. Patient was questioned postoperatively for variables of sore throat for three days. In group I, 12% patients complained of mild sore throat in comparison to group II where 6% suffered from mild sore throat [p>0.05]. There was no difference in the discomfort levels among males and females. Pharyngolaryngeal discomfort is less after use of LMA under spontaneous ve ntilation in comparison to controlled ventilation