Anesthetic management of an adult patient with hypertrophic obstructive cardiomyopathy and chronic kidney disease for minimally invasive video-assisted thoracoscopic surgery

It is not an uncommon situation to encounter a patient with anesthesia having multiple co-morbidities. Here, we report the successful anesthetic management of an immunosuppressed 53-year-old female patient with hypertrophic obstructive cardiomyopathy, stage IV chronic kidney disease, and chronic lung infection who was posted for minimally invasive video-assisted thoracoscopy requiring one lung ventilation. Intraoperative hemodynamic stability was maintained with etomidate, fentanyl, cisatracurium, desflurane, and dexmedetomidine with accurate bispectral depth for sedation and precise fluid guidance with transesophageal echocardiography. The entire anesthetic conduct was planned to avoid the left ventricular outflow tract obstruction and maintain a steady-state hemodynamic balance. This case report is a learning experience of how close vigilance with appropriate use of monitoring and knowledge about disease per se resulted in an uneventful perioperative period.

Gastric cancer with isolated leptomeningeal metastases: a case report.

Leptomeningeal carcinomatosis due to gastric cancer is rare. Gadolinium enhanced MRI and CSF analysis for malignant cells are necessary to confirm the diagnosis.

Endoscopic management of pancreatic diseases.

Endoscopic management has recently been used for a variety of chronic pancreatic diseases. We used this approach in five patients with pancreatic diseases (calcific pancreatitis 2, pancreatic pseudocyst 3). Nasocystic drain was placed in a patient with pancreatic pseudocyst at the tail end of the pancreas; a 5 Fr stent was placed over 0.021"/0.035" guide wire in the main pancreatic duct in the others. All patients had relief of pain. Nasocystic drain led to resolution of pseudocyst, perisplenic collection and pleural effusion. Endoscopic treatment is safe and effective in various pancreatic disorders.

HIV screening & risk behaviour in psychoactive substance users.

Patients admitted to the Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, were screened for HIV antibodies. Out of 116 patients, 45 (39%) were injecting drug users (IDUs), 29 (25%) were other drug users and 42 (36%) were primary users of alcohol. One IDU was HIV seropositive (2.2% of the IDUs). Analysis of HIV-related risk behaviour showed that the IDUs were at high risk, because of needle sharing as also because of having multiple sex partners. The potential for HIV infection in these persons practising high-risk behaviour calls for timely preventive measures.

Psychological assessment of blood related renal donors.

The impact of kidney donation on the psychological health of 31 living related donors was assessed by administering certain psychological tests before and after the operation (for donating the kidney). The results indicated a significant rise in the somatization subscale of the Middlesex Hospital Questionnaire (MHQ) from a mean of 1.61 to 3.23. There was no significant change in the other variables of these instruments or in the locus of control score. Only about one-fourth of the donors had prior knowledge of renal transplant. In almost all cases, the decision to donate had been voluntary and immediate, motivated by a concern for the recipient; there was virtually no second thoughts or regrets subsequently, which was apparently partly related to the opinions of other relatives who positively valued the act of donation.

Evaluation of a home care programme for the mentally retarded children through training of the mother.

Mothers of 80 children of mild (IQ 50-70) and moderate (IQ 35-49) mental retardation were selected for the present study. A carefully developed home training programme was utilized to train half of the mothers, the other half forming the control group for the study. The experimental and the control groups were matched for age and IQ of the children, and age of the mothers. The women also did not differ significantly on base-line marital adjustment and parental attitude scores and the experienced social burden of the mothers. In the experimental group there was a significant increase in the IQ and improvement in the behaviour of the children and significant improvement in the marital adjustment score, parental attitude and social burden felt by the mothers. There was no significant change in the control group in any of these variables.

Psychiatric symptoms in patients with non-organic chronic intractable pain.

Patients (200) with chronic intractable pain were evaluated to identify various psychiatric symptoms. Identifiable psychiatric illness, commonest being neurotic depression and anxiety states, was found in 72 per cent patients. The common symptoms reported on the present state examination (PSE) were worrying (77%), depression (40%), loss of interest (31.5%), hopelessness (16.5%), loss of weight (18%), and suicidal ideas (8%) and irritability (41.5%). Two thirds of patients had both anxiety and depression.