ABSTRACT
BACKGROUND: The application of skull pins in neurosurgical procedures is a highly noxious stimulus that causes hemodynamic changes and a rise in spectral entropy levels. We designed a study to compare intravenous (IV) labetalol and bupivacaine scalp block in blunting these changes. PATIENTS AND METHODS: Sixty-six patients undergoing elective neurosurgical procedures were randomized into two groups, L (labetalol) and B (bupivacaine) of 33 each. After a standard induction sequence using fentanyl, propofol and vecuronium, patients were intubated. Baseline hemodynamic parameters and entropy levels were noted. Five minutes before, application of the pins, group L patients received IV labetalol 0.25 mg/kg and group B patients received scalp block with 30 ml of 0.25% bupivacaine. Following application of the pins, heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), and response entropy (RE)/state entropy (SE) were noted at regular time points up to 5 min. RESULTS: The two groups were comparable with respect to their demographic characteristics. Baseline hemodynamic parameters and entropy levels were also similar. After pinning, the HR, SAP, DAP, MAP, and RE/SE all increased in both groups but were lower in the scalp block group patients. HR increased by 19.8% in group L and by 11% in group B. SAP increased by 11.9% in group L and remained unchanged in group B. DAP increased by 19.7% in group L and by 9.9% in group B, MAP increased by 15.6% in group L and 5% in group B (P < 0.05). No adverse effects were noted. CONCLUSION: Scalp block with bupivacaine is more effective than IV labetalol in attenuating the rise in hemodynamic parameters and entropy changes following skull pin application.
ABSTRACT
Fontan procedure is a palliative surgery done for patients born with single ventricle physiology. An understanding of the hemodynamic alterations in such a patient is important for successful perioperative management. We have discussed the anaesthetic considerations in a 12 year-old girl with complex congenital heart disease ultimately palliated by a Fontan operation, who was posted for Botox injections for upper limb spasticity under general anaesthesia.
ABSTRACT
Pulmonary edema is a rare complication of pre-eclampsia. We report a case of severe pre-eclampsia with abruptio placentae with intra-uterine fetal demise, complicated by pulmonary edema, managed under general anesthesia for caesarean section.
ABSTRACT
Tetralogy of Fallot is the most common cyanotic congenital heart disease. We report the anesthetic management of a patient with uncorrected Fallot's tetralogy for Cesarean section.