Unilateral pulmonary edema during laparoscopic resection of adrenal tumor.

Despite technological, therapeutic and diagnostic advancements, surgical intervention in pheochromocytoma may result in a life-threatening situation. We report a patient who developed unilateral pulmonary edema during laparoscopic resection of adrenal tumor.

Comparison of clinical performance of the I-gel with LMA proseal.

AIM: To compare insertion characteristics of 2 different supraglottic devices [I-gel and Proseal laryngeal mask airway (PLMA)] and to observe any associated complications. STUDY DESIGN: This prospective, randomized study was conducted in 80 patients [Group I - I-gel insertion (n = 40) and Group P - LMA Proseal insertion (n =40)] of ASA grades I/II, of either sex in the age group 18-65 years. Both groups were compared with respect to ease of insertion, insertion attempts, fiberoptic assessment, airway sealing pressure, ease of gastric tube placement, and other complications. MATERIALS AND METHODS: All patients were asked to fast overnight. Patients were given alprazolam 0.25 mg orally at 10 p.m. the night before surgery and again 2 hours prior to surgery with 1-2 sips of water. Glycopyrrolate 0.2 mg, metoclopramide 10 mg, and ranitidine 50 mg were administered intravenously to the patients 45 minutes prior to the surgery. Once adequate depth of anesthesia was achieved either of the 2 devices, selected using a random computerized table, was inserted by an experienced anesthesiologist. In group I, I-gel was inserted and in patients of group P, PLMA was inserted. STATISTICAL ANALYSIS: Student t-test and Mann-Whitney test were employed to compare the means; for categorical variables, Chi-square test was used. RESULT: Mean insertion time for the I-gel (11.12 ± 1.814 sec) was significantly lower than that of the PLMA (15.13 ± 2.91 sec) (P = 0.001). I-gel was easier to insert with a better anatomic fit. Mean airway sealing pressure in the PLMA group (29.55 ± 3.53 cm H2O) was significantly higher than in the I-gel group (26.73 ± 2.52 cm H2O; P = 0.001). Ease of gastric tube insertion was significantly higher in the I-gel group (P = 0.001). Incidence of blood staining of the device, sore throat and dysphagia were observed more in PLMA group. No other complications were observed in either of the groups.

Effect of intraoperative intravenous crystalloid infusion on post-operative nausea and vomiting after diagnostic gynaecological laparoscopy: Comparison of 30 ml/kg and 10 ml/kg and to report the effect of the menstrual cycle on the incidence of post-operative nausea and vomiting.

AIM: Primary To compare effect of 30 ml/kg and 10 ml/kg crystalloid infusion on post-operative nausea and vomiting after diagnostic gynaecological laparoscopy. Secondary To correlate incidence of post-operative nausea and vomiting associated with different phases of menstrual cycle. STUDY DESIGN: This prospective, randomized, double blinded study was conducted in 200 patients [Group I - 10 ml.kg(-1) crystalloid infusion (n = 100) and Group II - 30 ml.kg(-1) crystalloid infusion (n = 100)] of ASA grades I/II, of either sex in the age group 20-40 years undergoing ambulatory gynaecological laparoscopic surgery. Both groups were compared with respect to post-operative nausea vomiting, hemodynamic parameters and incidence of post-operative nausea and vomiting associated with different phases of menstrual cycle. STATISTICAL ANALYSIS: Data for categorical variables and continuous variables are presented as proportions and percentages and mean ± SD, respectively. For normally distributed continuous data, the Student t test was used to compare different groups. Categorical data were tested with the Fisher exact test. Pearson or Spearman correlation coefficients for data normally distributed and not normally distributed, respectively, were used to evaluate the relation between 2 variables. P values < 0.05 were considered statistically significant. RESULTS: In the first 4 h after anaesthesia, the cumulative incidence of nausea and vomiting in Group I was 66% as compared to 40% in Group II (P value = 0.036, *S). Anti-emetic use was less in the group II as compared to Group I (13% vs. 20%, P = 0.04). Female patients in the menstrual phase experienced nausea and vomiting in 89.48% of cases as compared to 58.33% and 24.24% during proliferative and secretory phases of menstrual cycle, respectively.

Anesthetic management of patient with systemic lupus erythematosus and thrombocytopenia for vaginal hysterectomy.

We report a case of a female having systemic lupus erythematosus, who was on steroid therapy and was scheduled for vaginal hysterectomy. She presented with breathlessness on mild exertion, a characteristic facial malar rash, and a platelet count 56,000 cells/cu mm. The patient was given a subarachnoid block with 2.8 ml 0.5% bupivacaine heavy in L3-L4 intervertebral space. Inj. Hydrocortisone 25 mg was given I.V. intraoperatively and repeated every 6 hours for 24 hours. Anesthetic management included considerations of systemic organ involvement, thrombocytopenia, and perioperative steroid replacement. Spinal block can be given with platelet count > 50,000/cumm. Strict asepsis should be maintained for invasive procedures. Maintenance of normothermia decreases the impact of Raynaud's phenomenon.