Anesthetic management of a patient with Bartter's syndrome undergoing bilateral sagittal split osteotomy

Bartter's syndrome is an unusual [estimated incidence is 1.2 per million people] but important congenital form of secondary hyperaldosteronism; due to abnormalities in renal handling of electrolytes. It is associated with hypertrophy and hyperplasia of the juxtaglomerular cells, normal blood pressure, and hypokalemic alkalosis withoutedema. We present a 22-year-old woman with Bartter's syndrome underwent bilateral sagittal split osteotomy to correct mandibular prognathic. The anesthetic management of Bartter's syndrome should be relevant to the pathophysiology of the syndrome. Therefore, it should be directed toward maintaining cardiovascular stability, control of associated fluid, electrolyte and acid-base derangements, and the prevention of renal damage

Mixed venous versus central venous oxygen saturation in patients undergoing on pump beating coronary artery bypass grafting

To examine the validity of central venous oxygen saturation [ScvO 2] as a numerical substitution of mixed venous oxygen saturation [SvO 2] in adult patients undergoing normothermic on pump beating coronary artery bypass grafting [CABG]. Prospective clinical observational study was done at King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. Thirty four adult patients scheduled for coronary artery surgery were included. Patients were monitored by a pulmonary artery catheter [PAC] as a part of our routine intraoperative monitoring. SvO 2 and ScvO 2 were simultaneously measured 15 minutes [T1] and 30 minutes [T2] after induction of anesthesia, 15 and 30 minutes after initiation of cardiopulmonary bypass [T3 and T4], and 15 and 30 minutes after admission to intensive care unit [T5 and T6]. ScvO 2 showed higher reading than SvO 2 all through our study. Our results showed perfect positive statistically significant correlation between SvO 2 and ScvO 2 at all data points. Individual mean of difference [MOD] between both the readings at study time showed MOD of 1.34 and 1.44 at T1 and T2 simultaneously. This MOD was statistically insignificant, but after on pump beating normothermic bypass was initiated; MOD was 5.2 and 4.4 at T3 and T4 with high statistical significance. In ICU, MOD continues to have high statistical significance, MOD was 6.3 at T5 and at T6 it was 4.6. In on pump beating CABG patients; ScvO 2 and SvO 2 are not interchangeable numerically. ScvO 2 is useful in the meaning of trend; our data suggest that ScvO 2 is equivalent to SvO 2, only in the course of clinical decisions as long as absolute values are not required

Preoperative nebulization of dexamethazone, racemic epinephrine and lidocaine in adults undergoing minor laryngeal surgery

Background and Objectives: The main objectives of anesthesia for laryngeal surgery are to provide the surgeon with immobile field with enough space for the rigid Iaryngoscope. Secured airway and ventilation, together with haemodynamic stability. It is equally important to promote rapid awakening and return of protective airway reflexes and to prevent possible respiratory complications such as cough, stridor, and laryngospasm. The aim of this study was to compare the effects of three different drugs given by nebulizing techniques administered in the immediate preoperative period. We compared dexamethazone, racemic epinephrine and lidocaine effects on postoperative respiratory complications and recovery after short-term laryngeal surgery in adults

Materials and Methods: Eighty ASA I-II patients aged 18-55 years of either sex scheduled for minor laryngeal surgery were included in this prospective, placebo-controiied, randomized, and double-blinded study. Patients were randomly allocated into four even groups according to the nebulized drug given, 20 patients each: Group I: 0.9% Normal Saline [control group], Group II: Dexamethazone 0.5 mg/kg, Group III; Racemic Epinephrine 2.25 % 0.01 ml/kg and Group IV; Lidocaine 1.5 mg/kg. All the drugs were prepared in 5 ml solution and given over 10 min periods by nenulizer in the holding area before shifting the patient to the OR. Recovery time has been recorded. Postoperative respiratory complications were assessed using Postoperative Respiratory System Evaluation Scoring [PRSES] at 1, 5, 10 minutes after removal of the rigid Iaryngoscope

Results: The occurrence of PRSES-1 [indicates no respiratory complications] was Significantly more frequent in group III [R-epinephrine] and group IV [lidocaine] in Comparison to both group I [control] and group II [dexamethazone] at the 1st, 5th, and 10th min after recovery. However, the frequency of PRSES-1 in group IV was significantly higher than group III, at all evaluation times. Dexamethazone group recorded significant prolonged recovery time compared to R-epinephrine group III. However it was insignificantly prolonged compared to both groups I and IV. Therefore, Patients of lidocaine group showed better recover criteria and lower incidence of respiratory complications compared to the other study groups

Conclusions: Nebulization of Lidocaine in the immediate preoperative period is very effective in reducing postoperative respiratory complications after short-term laryngeal surgery by way of rigid Iaryngoscope