role of transesophageal echocardiography in endovascular repair of traumatic aortic transection

Traumatic rupture of the thoracic aorta is a leading cause of death, following major blunt trauma, and endovascular repair has evolved as a viable alternative to open repair. This report highlights the role of transesophageal echocardiography as a valuable imaging tool for locating the exact position of the lesion, guiding placement of the endograft, detecting leaks around it and supplementing information derived from angiography during endograft deployment

Dynamic left ventricular outflow tract obstruction complicating aortic valve replacement: a hidden malefactor revisited

It is known that a dynamic left ventricular outflow tract [LVOT] obstruction exists in patients, following aortic valve replacement [AVR] and is usually considered to be benign. We present a patient with dynamic LVOT obstruction following AVR, who developed refractory cardiogenic shock and expired inspite of various treatment strategies. This phenomenon must be diagnosed early and should be considered as a serious and potentially fatal complication following AVR. The possible mechanisms and treatment options are reviewed

Prolonged muscle weakness following general anesthesia in a parturient on combined antiretroviral therapy - a case report

We report a case of an otherwise healthy; ambulatory 32 year old parturient on combined antiretroviral therapy that developed prolonged muscle weakness needing postoperative artificial ventilation. Despite no preoperative indication of muscle weakness, she developed respiratory insufficiency following general anesthesia with drugs that are deemed safe for her condition. After ruling out all the likely causes for her respiratory insufficiency that needed 12 hrs of artificial ventilation, we address the issue of undiagnosed preoperative muscle weakness as a likely cause for her problem. The role of a preoperative neurological evaluation to caution the anesthesiologist of the likelihood of a possible need for prolonged artificial ventilation following general anesthesia in this subgroup of patients, emphasized

Management of sickle cell disease during CABG surgery - A case report

Elective Coronary Artery Bypass Graft [CABG] surgery using cardiopulmonary bypass techniques following preoperative transfusions to increase the hemoglobin A levels to above 60%, in a male patient with sickle cell disease [SCD] is described. Avoidance of hypoxia and acidosis lead to an uneventful perioperative period. Our institutional protocol for preoperative transfusions is highlighted

prospective study of incidence of postoperative nausea and vomiting in a tertiary care hospital in Oman

This is a pilot study conducted in a tertiary referral center in Oman, to assess the incidence of postoperative nausea and vomiting [PONV] so that an institutional policy towards its alleviation could be evolved. This is a prospective study of 491 patients undergoing obstetric and gynecological, general surgical. pediatric and urological surgical procedures that received general anesthesia, regional anesthesia or a combination of both. Data regarding the incidence of PONV was collected and was documented in a standardized questionnaire based on the patient history, anesthetic protocol, a postoperative interview of the patient and a review of the nursing records. The over all incidence of PONV in our institution was 19.6%. The occurrence of vomiting compared to nausea or retching was high [p<0.01]. PONV was less in urological cases [p<0.05] compared to general surgical cases. The incidence of PONV was similar [p>0.05] in both groups, whether the patients received anti emetics along with pre-medication or not. PONV occurrence was significant in the first 6 hrs postoperatively [p<0.01]. In those patients who received propofol the prevalence of PONV was significantly less [p<0.01]. There should be a reassessment of the existing anti emetics in the institution Propofol was found to be a good anti emetic