Spontaneous Pneumomediastinum in a Patient with Covid-19.

Spontaneous pneumomediastinum is a rare diagnosis. A thirty-five-year-old female who was admitted to our hospital with fever, cough and breathlessness and positive RT-PCR for COVID -19 was diagnosed with spontaneous pneumomediastinum and pneumothorax. She was managed with symptomatic approach and oxygen therapy. Small pneumomediastinum usually requires close monitoring and follows an uneventful course.

Case series on successful anesthetic management of COVID-19-positive obstetric patients undergoing emergency cesarean section.

Coronavirus disease 2019 (COVID-19) outbreak was first reported in Wuhan, and its manifestations in pregnancy can be variable ranging from mild illness to severe acute respiratory syndrome. Management of such patients depends on severity of illness and gestational age. Case 1: A 67-year-old elderly primigravida with multiple comorbidities (type 2 diabetes, hypothyroidism, and intrahepatic cholestasis of pregnancy) and mild COVID-19 infection presented for emergency cesarean. Cesarean was conducted under spinal anesthesia after taking due personal protective equipment (PPE) precautions. Both mother and baby were discharged successfully. Case 2: A 24-year-old lady with severe COVID-19 illness who presented for emergency cesarean section was taken up under regional anesthesia with continuous positive airway pressure (CPAP) support. Intraoperative course went uneventful, and the patient was discharged after 12 days of intensive care unit (ICU) admission. Choice of anesthesia for a cesarean section is preferably regional anesthesia, whether the patient is COVID-19 positive or negative. Symptom management and optimisation is necessary in preoperative period the patient for surgery. Involvement of a multidisciplinary team approach with ICU care is helpful in successful management of the patient.

Propofol sparing effect of dexmedetomidine and magnesium sulfate during BIS targeted anesthesia: A prospective, randomized, placebo controlled trial.

BACKGROUND AND AIMS: Maintenance of adequate depth of anesthetic is crucial to prevent awareness and to reduce stress response associated with surgery. Goals of balanced general anesthetic are met by use of adjuvants to facilitate use of lower anesthetic dose, while ensuring adequate anesthetic depth. This study employed BIS monitoring to compare the anesthetic sparing effects of intravenous dexmedetomidine and magnesium sulphate on induction dose of propofol by maintaining a BIS value of 40-50. MATERIAL AND METHODS: One hundred and twenty ASA I and II patients undergoing elective surgery under general anesthetic were included in three groups of forty each. Group D received 1 µg/kg of dexmedetomidine, Group M was given 30 mg/kg of magnesium sulphate in 100 ml saline and Group N received 100 ml saline over 15-20 minutes 15 minutes before induction. Data compared were dose of propofol and vecuronium, Ramsay sedation score, BIS values and hemodynamic parameters intraoperatively. RESULTS: Propofol required in group D was significantly lower 101.3 ± 16.5 than group M and N with dose of 114 ± 15.5 and 160.50 ± 25.08 respectively (p <0.001). Dose requirement of vecuronium was significantly reduced in group M 5.4 ± 0.8 and group D 6.6 ± 1.2 as compared to N 7.9 ± 1.4 (p <0.001). No significant differences were seen regarding baseline hemodynamics, RSS and BIS values in all groups. After study drug infusion, RSS was 4.59 ± 0.75 in dexmedetomidine group compared to 1.9 ± 0.7 and 1.4 ± 0.5 in group M and N (p <0.001). During maintenance, significantly lower HR, MAP and BIS values were seen in group D and M than N (p <0.001). CONCLUSION: Our study showed that pretreatment with dexmedetomidine and magnesium sulphate significantly reduced the induction dose of propofol by maintaining a constant BIS in value at 40-50. However, both the drugs reduced the time to reach BIS 40-50 but sedation and sparing of propofol was more in dexmedetomidine group.