ABSTRACT
We report a case of a cannulated nasopharyngeal airway (NPA) in a patient having a neurological deficit, absent gag reflex, and no clinically obvious signs of respiratory distress. The patient had two episodes of vomiting before admission and was admitted with the initial working diagnosis of aspiration pneumonia; however, a preliminary chest X-ray (CXR) revealed an NPA, sitting vertically in the airway. It is our emphasis that thorough clinical history and radiological imaging are of paramount importance in prompt management of such airway complications.
ABSTRACT
In this paper we show how the Shannon entropy is connected to the theory of majorization. They are both linked to the measure of disorder in a system. However, the theory of majorization usually gives stronger criteria than the entropic inequalities. We give some generalized results for majorization inequality using Csiszár f-divergence. This divergence, applied to some special convex functions, reduces the results for majorization inequality in the form of Shannon entropy and the Kullback-Leibler divergence. We give several applications by using the Zipf-Mandelbrot law.
ABSTRACT
BACKGROUND: Post-operative pain is often inadequately treated. Optimal utilization of the available resources is essential for improving pain management. AIMS: The aim of our study was to determine pain management strategies employed after major abdominal surgeries at our institute and their efficacy and safety. SETTINGS AND DESIGN: Prospective observational study conducted at a tertiary care hospital. MATERIALS AND METHODS: Patients undergoing elective major abdominal surgeries were included. Post-operative analgesic strategy, co-analgesics used, pain and sedation scores, motor block, nausea and vomiting were recorded and patient satisfaction was determined. RESULTS: Data was collected on 100 patients. Epidural analgesia was used in 61, patient controlled intravenous analgesia (PCIA) in 25 and opioid infusion in 14 patients. Multimodal analgesia was employed in 98 patients. The level of epidural was between L1-L3 in 31, T10-L1 in 20 and T8-T10 in 10 patients. Pethidine was used in 80% of patients receiving PCIA. Patients with epidurals at T8-T10 had lower pain scores. Fifteen patients had motor block, 73% of which were with epidural at L1-L3. Fourteen patients complained of nausea. Ninety nine out of 100 patients were satisfied with their analgesia. CONCLUSION: Epidural, PCIA and opioid infusions are used for pain relief after major abdominal surgeries at our hospital. Although there is limited drug availability, regular assessments and appropriate dose adjustments by acute pain management service (APMS) and use of multimodal analgesia led to a high level of patient satisfaction. We recommend that feedback to the primary anesthesiologists by APMS is of utmost importance to enable improvement in practice.
ABSTRACT
INTRODUCTION: Eisenmenger's syndrome in pregnancy can lead to death in 50% to 65% of parturients. Expensive invasive monitoring and medication have improved management and outcomes. Cheaper alternatives for the management of high-risk patients who present with no prenatal care are still not available. CASE PRESENTATION: We describe the obstetric anaesthesia management of a 34-year-old, 34-weeks pregnant woman who presented with a recent diagnosis of severe Eisenmenger's syndrome. A combined spinal epidural anaesthesia was used together with invasive cardiac monitoring as well as PGE1 nebulisation after delivery of the baby. This helped achieve a reduction of shunt, improvement of hypoxia and reduction of pulmonary pressures. CONCLUSION: We found this to be a cheaper and safe alternative in the management of such patients who present with no adequate prior management.
