Bupivacaine induced aseptic meningitis following subarachnoid block

All anesthesiologists performing subarachnoid block should be familiar with the possible sources of contamination during the procedure and means to prevent them. Despite following stringent practices of asepsis by the anesthesia care givers there can still be a rare possibility of iatrogenic meningitis due to the spinal anesthesia. We report a rare case of aseptic meningitis succeeding subarachnoid block in our institute, probably by hyperbaric bupivacaine, injected in the subarachnoid space and its subsequent management

Paroxysmal autonomic instability with dystonia (PAID) syndrome following cardiac arrest

Paroxysmal autonomic instability with dystonia (PAID) appears to be a unique syndrome following brain injury. It can echo many life-threatening conditions, making its early recognition and management a challenge for intensivists. A delay in early recognition and subsequent management may result in increased morbidity, which is preventable in affected patients. Herein, we report the case of a patient who was diagnosed with PAID syndrome following prolonged cardiac arrest, and discuss the pathophysiology, clinical presentation and management of this rare and under-recognised clinical entity.

Newer oral anticoagulants in perioperative settings

Newer oral anticoagulant agents [NOACs] have several potential merits over previously used vitamin K antagonists [VKAs] during the perioperative period, including a wider therapeutic index, higher efficacy, quicker onset and offset of action, high oral bioavailability, less need for monitoring, reduced variability in dose response and drug/dietary interactions and less adverse effects. These oral anticoagulants have discrete targets within the coagulation pathway. The patients on these drugs often present to anesthesiologists for routine or emergency surgery, hence the awareness of the pharmacological profile of these newer drugs is imperative to attain its optimal response. This update describes some of the new generation oral anticoagulants and focuses on its merits and demerits in the existing perioperative settings

Prehospital trauma care services in developing countries

Trauma is a leading cause of death and disability especially amongst young people. Prehospital trauma care service remains a dynamic field of medicine for care of trauma patients. The goal of prehospital emergency care system should be to match the needs of the patients to the available resources so that optimal, prompt and cost-effective care can be offered. For bridging the wide gap between the actual and expected level of care, the urgent need must be appreciated by the community, administration, medical professionals and very positive steps should be taken to meet the future challenges. The authors included a "snapshot" of current articles applicable to prehospital trauma care in developing countries. The current review aims to explore the concept of "golden hour" and objectives, controversies and existing status of prehospital trauma care service using the recent evidence based literature in developing countries

Two point fixation of endotracheal tube in submentotracheal intubation during craniomaxillofacial surgeries-our experience!

Airway management in the craniomaxillofacial trauma surgery may require some modifications of the standard intubation techniques. Nasotracheal intubation is often not an option in panfacial and midfacial injuries due to the probable presence of fractures of base of the skull and associated risk of brain trauma and iatrogenic meningitis. Submental endotracheal intubation may serve as an effective and safe alternative route in these conditions. In standard technique of submentotracheal intubation, the tube is fixed extraorally at the submental incision site with sutures to prevent displacement of the tube during the surgical intervention. But still it leaves a possibility of accidental extubation during the conversion of orotracheal to submental route and vice versa. To counteract this problem we in our institution, fix the tube at two points, one at molar teeth in intraoral region and second at skin surface externally near submental incision site ensuring a secured airway. This procedure has eliminated accidental displacement or extubation in our cases

Successful intubation in a child with Lowe syndrome using fiberscope and Glidescope[registered sign]

We report the airway management in anticipated difficult airway of a two year old male child with diagnosis of Lowe syndrome, employing two airway management devices. Fiberscope assisted Glidescope[registered sign] intubation was employed to manage the difficult airway. Lowe syndrome is a rare inherited metabolic disorder with hypotonia, delayed motor and mental milestones, renal dysfunction and hypokalemia. The child had an anticipated difficult airway by virtue of large head circumference with frontal bossing, retrognathia and high arched palate. A careful preanesthetic evaluation and discrete attention to the distinctive components of the syndrome are the essence of successful perioperative management. Airway management in these patients requires standard algorithmic approach to difficult airway with careful selection of ventilation and intubation techniques and aids suitable in these situations to prevent any catastrophes