RESUMO
Percutaneous device closure of Atrial Septal Defect (ASD) is a commonly used technique as an alternative to surgery with advantages of avoidance of sternotomy, short hospital stay, and fewer complications. However, it may lead to life-threatening complications such as device embolization. We here, report such a case of embolization of the ASD occluder device causing right ventricular inflow obstruction and severe cardiopulmonary compromise. The anaesthesiologist plays the role of a team leader in diagnosing and managing such an emergency from cath lab to transfer of the patient till the retrieval of the device and discharge of the patient.Atrial septal defect is one of the commonest congenital heart diseases (3.78 / 10000). Shunts from ASD are detected in childhood or young adulthood and are well tolerated in infants and young children, but symptoms of mild fatigue, poor growth or dyspnoea on exertion may be present.(1) Thus, early closure should be considered in such infants. If the defect is small, it may not require any intervention. The shunt, tends to increase with age, and repair is required when ASD is diagnosed.1 Patients with huge defect closure to be done between 2 - 5 yrs. Total intravenous anaesthesia or MAC (Monitored Anaesthesia Care) is given in maximum interventional cardiology procedures as patient is required to stay still for up to 1 hr.2 Percutaneous transcatheter closure of the defect is most frequently done for ASD closure.3,4 It avoids the need for surgery, and is related to few complications.3,5 However, complications such as cardiac perforation, fistula formation, thrombosis, arrhythmia (2.6 %) device dislodgement (3.5 %) both to the systemic and pulmonary circulation.6 They may lead to haemodynamic compromise, inflow or outflow obstruction, which calls for immediate retraction. This is a case of right ventricular inflow obstruction due to embolised closure device.
RESUMO
Post-operative pain frequently hampers implementation of day care arthroscopic knee surgery in spite of so many analgesic, local anaesthetic drugs and routes of administration. The aim of this study was to evaluate the efficacy and safety of intraarticularly administered inj. ropivacaine 0.25% 20 ml, after arthroscopic knee surgery performed under spinal anaesthesia, for prolonging the duration of post-operative analgesia.METHODSThis is a prospective randomized study conducted among 80 patients of both sexes, of American Society of Anesthesiologists, physical status I and II, undergoing day care arthroscopic knee surgery who were randomly assigned into two groups (R, C). Group R received 20 ml of 0.25% ropivacaine, whereas group C received 20 ml of 0.9% inj. normal saline through intra-articular route at the end of the procedure. Pain was assessed using visual analog scale (VAS) and paracetamol given as rescue analgesic when VAS >4. Time of first analgesic request and total rescue analgesic were noted.RESULTSTime for the requirement of first post-operative rescue analgesia (255.15±26.35 vs. 92.40±12.54) min and total mean rescue analgesic requirement was (1.32±0.52 vs. 3.0±1.0) in group R and C respectively. Group C had higher mean VAS score throughout the study period. No side effects were found among the groups. These two results were clinically and statistically significant (p<0.05).CONCLUSIONSAdministration of intra-articular inj. ropivacaine 0.25%, 20ml, is effective & safe method of management of postoperative pain in patients undergoing arthroscopic knee surgeries, as it prolongs the duration of postoperative analgesia, provides better quality of analgesia with reduced requirement of rescue analgesia without significant side effects.