RESUMO
Transuretheral resection of prostate (TURP) is one of the most commonly performed urological procedure. Though considered to be safe, it is sometimes associated with atypical complications. We hereby report a successful anaesthetic management of bladder explosion, a very rare complication of TURP, occuring towards the end of the procedure at the time of removal of resectoscope. The prompt recognition and management of the same led to uneventful postoperative course.
RESUMO
Hypertrophic cardiomyopathy (HOCM) is a complex cardiac disorder of genetic origin. Though the patients may be asymptomatic the stress of surgery and anaesthesia is known to exacerbate the left ventricular outflow tract (LVOT) obstruction leading to catastrophic complications. We hereby report a successful anaesthetic management of a patient with left intertrochantric fracture diagnosed with HOCM. Careful and meticulous strategies to prevent LVOT obstruction led to entire uneventful introperative and perioperative course.
RESUMO
Our case report is regarding a patient who is a k/c/o citrullinemia type 1 which is a defect in urea cycle posted for facture patella reduction surgery (tension band wiring). He was intellectual disabled because of persistent hyperammonaemia before diagnosis that was controlled with benzoate and L- arginine. Patient preoperative fasting was kept to the minimum and taken as 1st case in the operation theatre. Drugs taken orally on routine basis were continued along with serum ammonia monitoring. Clonidine with midazolam along with propofol infusion to decrease protein hypercatabolism due to stress and to get co-operation of the patient for femoral sciatic block. Postoperative ammonia levels were normal. Sedation is considered useful for preventing hyper ammonemia. Preoperative endocrinology consultation, perioperative serum ammonia level monitoring and coordination between various health departments (nephrologist and endocrinologist) for appropriate care in case of hyper ammonemia and hyperglycaemia perioperatively.
RESUMO
Post-operative nausea and vomiting (PONV) is one of the commonest complications in anaesthesia accounting for 20-30% cases but number may rise to 70% in laparoscopic surgeries.1,2 Laparoscopic cholecystectomy is carried out as day care surgery but PONV prolongs hospital stay. Several studies have documented role of Gabapentin and Dexamethasone for prophylaxis of PONV but none has compared them for the same. This study aimed at comparing the efficacy of oral gabapentin and dexamethasone for prophylaxis of PONV and need for rescue anti-emetics in first 24 hours. Methods: This prospective, single blind randomized trial enrolled 100 ASA physical status I and II patients assigned into two groups: Group G (Gabapentin group, n=50) received 600 mg of Gabapentin oral formulation with sip of water on the morning of surgery whereas Group D (Dexamethasone group, n=50) received 8 mg of Dexamethasone oral formulation with sip of water on the morning of surgery. Following parameters were noted: time to first rescue anti-emetic drug (Injection Ondansetron), total number of rescue anti-emetic doses, complications if any. Results: The two groups i.e the Gabapentin group and the dexamethasone group were comparable with regards to the demographic profile (age, weight and sex). However the mean duration of surgery was more in Gabapentin group compared to Dexamethasone group, the difference being statistically significant (P< 0.05). Time between extubation and first rescue antiemetic was also comparable in the two groups the results being statistically non significant (P > 0.05). The mean of total number of rescue antiemetics in 24 hours as well as grading of Wilsons score for PONV in the two groups was also statistically non significant (P > 0.05). Conclusion: Both the drugs gabapentin and dexamethasone are equally effective in preventing postoperative nausea and vomiting.
RESUMO
Spinal Anaesthesia is widely practiced anaesthetic technique for sub - umbilical surgical procedures. However the technique is not without complications and Post Dural Puncture Headache (PDPH) remains important amongst such complications. Aims and Objectives: The present study was prospective , was conducted to study the overall incidence of PDPH using 26 G Quincke type spinal needle and to establish its relations( if any) with the age of patient, type of surgery and time to ambulate following the surgery. Methods: A total of 500 patients of ASA I and II were studied. These patients underwent various orthopaedic, general surgical, obstetrical/ gynaecological surgical procedures under Spinal Anaesthesia using 26 G Quincke type spinal needle. All the patients were followed upto 72 hours post operatively for evaluation of PDPH. Results: The incidence of PDPH in the present study was 1.6%. The incidence was higher in female patients (75%). Among the female patients, 50% of patients were those who underwent Caesarean Section. Conclusion: The present study concludes free and widespread use of 26 G Quincke type needle in all patients who require Spinal Anaesthesia irrespective of type of surgery