Resolution of a large left ventricular thrombus with anticoagulation alone

Dilated cardiomyopathy and the resultant left ventricular dysfunction are risk factors for thrombus formation in the heart, reflecting the intimate relationship between structure and function in this vital organ. Once formed, depending on size, location, and mobility, left ventricular thrombi have the tendency to embolize, sometimes with dire consequences. Proper management of these thrombi is still controversial. We present a case of an unusual large thrombus, which resolved with anticoagulation therapy alone, giving hope that more invasive intervention can safely be circumvented

Combined spinal-epidural anesthesia [CSEA] single space technique [SST]

Combined spinal-epidural anaesthesia in a single space has been used since 1981 on 14816 patients. Lumbar [L] 2-3 or L3-4 space was punctured by tuohy needle. Spinal needle [25 or 26G] was then passed through epidural needle while its bevel was in caudal position in the epidural space. After injecting local anaesthetic [3.5 ml bupivacain] through spinal needle once it has pierced the subarachnoid space, spinal needle was taken out. Epidural catheter was passed after turning the bevel of epidural needle cephalad. Segmental spread was assessed by pinprick. Advantages of both spinal-epidural anaesthesia has been obtained by this technique apart from post operative pain relief