Ultrasound is here to stay

Only in a few decades, ultrasonography has revolutionized the diagnostic approach in many of the medical specialties. Although the obstetricians were the first ones to use it to the advantage of the patients, many other medical and surgical specialties followed them. Anesthesiologists were not very late in this race, and they soon studied and found its multiple uses in the practice of anesthesiology, interventional pain management, intensive care, trauma and resuscitation. Huge cost on the ultrasound machines, administrative inertias and lack of adequate training facilities have been the main obstacles in adopting this modality to its full potential in non-developed countries. It's the need of the time that cheaper but adequate versions of the machines are developed and due stress is laid on the professional training in its use at all postgraduate training courses

Malignant hyperthermia: survival without dantrolene - a case report

We encountered a case of malignant hyperthermia in a 52 year old male undergoing open reduction/internal fixation of humerus fracture under general anesthesia. Isoflurane has been reported as a potent triggering agent of malignant hyperthermia. Dantrolene remains the gold standard for treating this life threatening syndrome but it is not available in many countries including Pakistan. However, we successfully managed our patient by timely recognition of this syndrome and administering prompt and effective symptomatic treatment

Hemiplegia caused by inadvertent subclavian artery double-lumen catheterization

Arterial puncture during central venous catheterization [CVC] is a relatively rare complication that may have devastating consequences. We present a case of left sided hemiplegia after inadvertent, unidentified right subclavian artery double-lumen catheterization in a 60 years aged male who had to undergo central venous catheterization for hemodialysis. The patient had had hemodialysis from the same intra arterial route thrice. Twenty days later, he was successfully managed in OR by removal of the catheter from his artery and manual compression for 20 minutes to control the bleeding