Dolichoectasia of vertebrobasilar artery presenting as facial pain: a case report

Dolichoectasia of the intracranial arteries is a rare condition characterized by elongated and tortuous arteries due to progressive destruction of the vessel walls. Although most patients present with cerebrovascular accidents, our patient presented with intractable facial pain along the distribution of the trigeminal nerve. Clinical examination revealed involvement of the 5th, 7th, and 8th cranial nerves, and subsequent MRI showed dolichoectasia of the left basilar artery. The patient experienced symptomatic relief after a trial of carbamazepine along with botulinum toxin injections.

Persistent idiopathic facial pain treated with botulinum toxin and pulsed radiofrequency of infraorbital nerve – a case report

Persistent idiopathic facial pain is a rare and difficult condition to treat. Several pharmacological, nonpharmacological, and invasive treatment options have been used, with varying results. We report the case of a patient with intractable persistent idiopathic facial pain who responded favorably to a combination of botulinum toxin injections and pulsed radiofrequency treatment of the infraorbital nerve.

Successful use of Gasserian ganglion block for maxillo-mandibular fixation in a patient with severe pulmonary dysfunction-a case report

Various anesthetic techniques have been utilized for maxillo-mandibular fixation. We report the case of a patient with bilateral condylar and zygomatic arch fractures who had severe pulmonary dysfunction. The patient was administered bilateral image-guided Gasserian ganglion block through the foramen ovale to achieve surgical anesthesia. The technical details, advantages, and disadvantages of this rather unusual technique are discussed.The procedure could be a feasible technique when performed meticulously in cases where other approaches are deemed difficult.

Comparison of postoperative analgesia with 0.8 mg and 1.6 mg intrathecal nalbuphine; a randomized controlled trial

Background and Objectives: Intrathecal opioids provide an easy and efficient method of prolonging postoperative analgesia due to its action on the spinal opioid receptors. Nalbuphine is a mixed opioid agonist - antagonist which has better side effect profile than morphine. It is easily available in India without a need for narcotics license. The optimal dose of nalbuphine as an adjuvant to intrathecal bupivacaine is not known, as the availability of other narcotics, e.g. fentanyl, sufentanyl etc., in the West has diminished the need to use, and thus to research partial opioids like nalbuphine. The aim of our study was to compare the duration of postoperative analgesia with 0.8 mg and 1.6 mg of nalbuphine when used as an additive with 0.5% hyperbaric bupivacaine in patients undergoing lower abdominal and lower limb surgeries

Methodology: 66 patients undergoing various lower abdominal and lower limb surgeries were randomized into 2 groups and received either 0.8 mg or 1.6 mg intrathecal nalbuphine with 3.2 ml of 0.5% hyperbaric bupivacaine. The duration of postoperative analgesia, hemodynamic stability and incidence of adverse effects were noted

Results: The mean duration of postoperative analgesia in 0.8 mg and 1.6 mg group were 247 +/- 12 and 239 +/- 10 min respectively [p = 0.007]. The incidence of bradycardia was more in 1.6 mg group but did not reach statistical significance. The inability of the higher dose to achieve longer analgesia might be due to a ceiling effect and anti-analgesic actions of nalbuphine

Conclusion: A dose of 0.8mg of nalbuphine as an intrathecal adjuvant seems to be optimal for providing prolonged post operative analgesia with minimal side effects

Handheld devices and informatics in anesthesia

Handheld devices like smartphones, once viewed as a diversion and interference in the operating room have become an integral part of healthcare. In the era of evidence based medicine, the need to remain up to date with current practices is felt more than ever before. Medical informatics helps us by analysing complex data in making clinical decisions and knowing recent advances at the point of patient care. Handheld devices help in delivering such information at the point of care; however, too much reliance upon technology might be hazardous especially in an emergency situation. With the recent approval of robots to administer anesthesia, the question of whether technology can replace anesthesiologists from the operating room looms ahead. The anesthesia and critical care related applications of handheld devices and informatics along with its possible drawbacks are discussed