A Rare Presentation of Thyroid Mass- A case report.

Background-Respiratory symptoms are not uncommon in thyroid diseases and can be overlooked and misdiagnosed as acute exacerbation of asthma or COPD. Case report- A 58 years old female presented to emergency department with complaints of fever, shortness of breath from last 3-4 days for which she intubated in emergency department and shifted to ICU. Next day patient was absolutely fine and extubated and was planned to be shifted out surprisingly the same episode was repeated following which patient was intubated again and was found to be absolutely normal after 3-4 h and extubated again. The same episode was repeated next day as well. Eventually she was diagnosed to have cystic thyroid swelling. Immediate aspiration of the cyst done to relieve the symptoms and total thyroidectomy was done subsequently and patient was cured of the symptoms. Conclusion- Acute airway obstruction can occur in asymptomatic goitre patients. The anaesthetic management is crucial for airway till definitive surgery is done. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03179-x.

A Comparative Study to Confirm the Endotracheal Tube Placement Using Ultrasonography and Standard Auscultation Method in Children.

BACKGROUND: In pediatric patients due to shorter trachea suboptimal positioning of endotracheal tube (ETT) is seen in 20%-50% of patients triggering grave complications. We compared standard auscultation and ultrasound-guided lung sliding to confirm the position of ETT in children. METHODS: Seventy-five pediatric patients between 2-8 years of age, American Society of Anesthesiologists physical status classification I and II scheduled for surgery under general anesthesia with endotracheal intubation were studied. The position of ETT was confirmed by chest auscultation for the breath sounds bilaterally and by ultrasound on the same sites for lung-sliding signs. The data obtained were compared to findings on waveform capnography. Study outcomes included position of the ETT; tracheal or esophageal, accuracy of diagnosis and time taken till confirming the diagnosis. RESULTS: Compared to waveform capnography findings, an ultrasound revealed a sensitivity of 94.31%, a specificity of 72.33%, and an accuracy of 90.7% while that for standard auscultation were 82.8%, 47.28%, and 74.67%, respectively. The mean time taken for confirmation of ETT position was significantly shorter with waveform capnography (10.29 ± 2.25 s) compared to auscultation (12.96 ± 2.23 s) and ultrasonography (USG) (14.28 ± 3.77 s). CONCLUSION: Confirmation of ETT position using USG or waveform capnography is essential because of high false results using standard auscultation alone. Ultrasound-guided lung sliding method is a simple, fast, and a reliable method used for detecting tube malposition.

A prospective study to evaluate the efficacy of ultrasound-guided ganglion impar block in patients with chronic perineal pain.

BACKGROUND: The blockade of the ganglion impar has been described to relieve the intractable perineal pain of sympathetic origin in patients with coccydynia. Chronic perineal pain (CPP) has been effectively managed by ganglion impar block. The feasibility, safety, and efficacy of ultrasound (US)-guided ganglion impar block by transsacrococcygeal approach was analyzed in the present study. METHODS: A total of 15 patients with CPP were administered US-guided ganglion impar block using out of plane approach. Patients were followed for VAS and quality of life using Karnofsky performance status (KS), Linear Analog Scale Assessment (LASA), and constipation score up to 2 months at different time intervals. Time required to perform the procedure, number of attempts, and any complications were also noted. RESULTS: The mean time required to perform the procedure was 7.67 ± 1.23 min. There were no adverse events. All the patients had significant pain relief during 2 month follow-up (P < 0.05 compared to baseline VAS). The KS and LASA score improved post block which was statistically significant. The dose of nonsteroidal anti-inflammatory drugs (NSAIDS) decreased from preblock state with statistically significant difference, while the difference in dose of tramadol and morphine was statistically insignificant. CONCLUSION: US-guided ganglion impar block is technically feasible and safe technique. USG can be used to locate sacrococcygeal junction (SCJ) and facilitate the performance of ganglion impar block. The efficacy and safety of the US-guided ganglion impar blockades needs a proper evaluation in the randomized controlled trials.