RESUMEN
Pregnant patients with uncorrected Double Outlet Right Ventricle (DORV) undergoing cesarean section are challenging for anesthesiologists. We present a case of a 24?year?old woman with a gestational age of 30–32 weeks with DORV, ventricular septal defect, pulmonary hypertension, and stage C functional class III heart failure who was successfully managed using a combination of low?dose spinal anesthesia bupivacaine 0.5% 7.5 mg with adjuvant fentanyl 50 mcg and epidural ropivacaine 0.2%, and fentanyl 50 mcg TV 10 cc given 30 minutes after the birth of her baby. Hemodynamics was stable after low?dose spinal anesthesia and until the end of the operation.
RESUMEN
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, characterized by aortic overriding, right ventricular hypertrophy, pulmonary stenosis (PS) and ventricular septal defect (VSD). When left untreated, survival to adulthood is rare. There are few case reports of uncorrected TOF surviving to adulthood and then presenting for noncardiac surgeries. We present a case of debridement of a necrotizing fasciitis under low dose spinal anaesthesia, in a patient of uncorrected TOF with scoliosis and cushingoid features.
RESUMEN
Background:Fentanylis a phenylpiperidine derivative synthetic opioid agonist. As an analgesic fentanyl is 75-125 times more potent than morphine. Sufentanil is a semisynthetic thienyl analogue fentanyl with analgesic potency 5 to 10 times more than that of fentanyl. Recently there has been an interest in using analgesics and localanaesthetics in an attempt to decrease the local anaestheticdose enabling fasterrecovery.Methods:A double blinded randomised study was carried out with 50 patients of ASA grade I and II aged between 20 and 60 years undergoing elective inguinal and below inguinalregionsurgeriesunder low dose spinal anaesthesia. Patientsreceived 10 mg of 0.5% hyperbaric bupivacaine with 50 μg of fentanyl added to a total volume of 3 ml(group F),and with sufentanil 5 μg [diluted with 5% dextrose] and volume made to 3 ml(group S). Postoperative VAS score for pain, duration of motor block and complications postoperatively is noted.Results:Prolonged postoperative analgesia was observed in group F (216.7min) and group S(264.8)which was statistically significant among the groups (p<0.001) is higher in group S and also duration of motor block in group F(130.6) and group S (90.5) which was statistically significant among the groups (p<0.001) which is higher in group F than group S. Conclusions: When compared to intrathecalbupivacaine-fentanyl combination; intrathecal bupivacaine-sufentanil combination provided prolonged postoperative analgesia with a lesser duration of motor blockade thus allowing early post operative ambulation
RESUMEN
Background: The use of subarachnoid block has become an established and reliable method of providing anaesthesia for lower abdominal and lower limb surgery. Regional anaesthesia is generally well tolerated by all patients, producing less postoperative confusion and delirium than general anesthesia. It is also associated with lesser incidence of post-operative thromboembolism. However subarachnoid block has got its own inherent complications, especially related to cardiovascular stability.Aim: to compare the haemodynamic ,sensory and motor effects of a low dose bupivacaine – clonidine spinal anesthesia versus conventional dose of bupivacaine in patients undergoing lower limb surgery.Method: Prospective, randomized double blind study was undertaken in 60 selected patients posted for lower limb surgeries. Data were collected for duration and onset of motor and sensory effects, haemodynamic changes and side effects of study drugs and they were statistically analyzed.Results: We found in our study that time of onset of adequate level of sensory block (T10) was significantly longer for group B which contains 30μ gm of clonidine (126±14) than group A (95±10). The total duration of sensory block for Group A was 227.6±9.8 mins while Group B had 351.9± 17.5 mins and motor block for group A was 162.5±7.51 mins while in group B had 274.8±14.4 mins. Conclusion: Clonidine when combined with low dose bupivacaine has prolonged the duration of motor and sensory blockage and incidence of intra operative pain with maintaining haemodynamic stability.