ABSTRACT
Tracheobronchial injuries are rare cases requiring skillful airway management. We report a challenging case of tracheobronchial injury in a young adult who was run over by a tractor and was referred to us from a peripheral hospital with endotracheal tube in situ. He was severely hypoxaemic on initial presentation. Diagnostic work up showed high suspicion for right bronchial transection along with left lung upper lobe contusion. Due to deteriorating clinical condition of the patient and despite immediate unavailability of fibreoptic bronchoscope, patient was immediately taken up for right posterolateral thoracotomy and double lumen tube was inserted. The position of the tube was confirmed clinically. As soon as the fibreoptic bronchoscope arrived, it was again used to confirm the position of double lumen tube. Patient's clinical condition improved after repair of the injured right bronchus and he was later extubated the next day.
ABSTRACT
PURPOSE: The migration of an epidural catheter into the intravascular and subarachnoid spaces sometimes occurs. This study was designed to investigate where the resistance was felt during the advancing of the catheter into the epidural space and whether the length of catheter advanced in the epidural space affected the incidence of catheter migration. METHODS: One hundred and twenty women, American Society of Anesthesiologists (ASA) 1 or 2, scheduled to undergo lower abdominal surgeries with epidural anesthesia were randomly assigned to two groups according to the length of the epidural catheter advanced; 4 cm (n = 60) or 8 cm (n = 60). The length where resistance to advancing the catheter was perceived was recorded in all patients, and the incidence of aspiration of blood or cerebrospinal fluid (CSF) was obtained. Further, the catheters removed 48 h after surgery were scrutinized for their bending sites. RESULTS: Resistance was felt in 83 (69.2%) patients and the mean length in the epidural space at which resistance was found was 2.5 +/- 1.2 cm. Blood was aspirated in 9 (7.5%) patients when resistance to advancing the catheter was overcome, but CSF was aspirated in no patient. A distal bend was observed 2.4 +/- 1.3 cm from the tip of the catheter, and the sites of bending were correlated with the length where resistance was encountered. An additional proximal bend was observed in 35 (58%) patients in the 8-cm group, and in 2 patients (3%) in the 4-cm group (P < 0.001), probably due to coiling of the catheter. CONCLUSION: At approximately 2.5 cm in the epidural space, advancing an epidural catheter causes resistance. Further advancing past this point may cause migration of the catheter into the vessels, or the coiling of the catheter.
Subject(s)
Anesthesia, Epidural/methods , Anesthesia, Obstetrical/methods , Catheterization/methods , Adult , Analgesia, Patient-Controlled , Analgesics, Opioid/administration & dosage , Anesthesia, Epidural/adverse effects , Anesthesia, Obstetrical/adverse effects , Catheterization/adverse effects , Epidural Space/anatomy & histology , Epidural Space/physiology , Female , Foreign-Body Migration/epidemiology , Humans , Morphine/administration & dosage , Pain Measurement , Preanesthetic Medication , PregnancyABSTRACT
Sixty patients aged 15 to 40 years of either sex, American Society of Anaesthesiologists (ASA) grade I and II, undergoing tonsillectomy, were randomly allocated to receive either preroperative intramuscular diclofenac sodium(group A) or pre- incisional bilateral infiltration of bupivacaine in the peritonsillar fossa (group B) or post operative Trunscutaneous Electric Nerve Stimulation - TENS (group C) at fixed time intervals. Pain scores (Visual analogue scale VAS, 0- 100 mm) were assessed at rest and on deglutition at 1,3,6,9,12 and 24 hours after surgery. Pentazocine 1actale 15 mg IV was given as rescue analgesic whenever VAS estimation was more than 30 mm at rest (not deglutition). Constant incisional pain was significantly less ( p < 0.01 ANOVA) in group C after 3 hours of surgery as compared to group A and B. Similarly pain on deglutition was significantly less (p <0.01, ANOVA) in group C during the entire study period as compared to Group A and B. There was significant reduction of VAS (p< 0.01) immediately after TENS therapy at 0, 4 and 8 hours. Rescue analgesic consumption was significantly lower in TENS group. Thus, TENS seems to be an effective therapeutic modality for post tonsillectomy pain relief as compared to the other two methods.