ABSTRACT
Lutembacher's syndrome is a rare congenital cardiac syndrome comprising of a combination of an atrial septal defect complicated by congenital or acquired mitral stenosis. The applied physiology of the patient depends upon the severity and the interactions of the lesions. They pose certain difficulties to the administration of both general or neuraxial anesthesia. A preference of one form of anesthesia over the other should be based on the understanding of the physiology of the patient. There should not be an orthodox avoidance of neuraxial anesthesia in complex cardiac pathologies as general anesthesia can be associated with certain complications of its own. Here, we report our successful experience of neuraxial anesthesia being administered in a patient with Lutembacher's syndrome.
ABSTRACT
ProSealTM Laryngeal Mask Airway (PLMA) (Teleflex Medical, Westmeath, Ireland) is a versatile and popular reusable supraglottic airway device. The manufacturer advises maximum reuse of up to 40 times. However, excessive reuse of the device can cause rare complications. Here, we report a rather uncommon complication of intraoperative cuff rupture of a PLMA probably due to the combination of a forceful metal introducer tip insertion and nitrous oxide-based anaesthesia.
ABSTRACT
Background: There has been considerable debate regarding the ideal anaesthetic technique for Percutaneous Nephrolithotomy (PCNL). PCNL is usually performed under general anaesthesia (GA) in prone position. The prone position under GA is associated with various complications. To address these complications, our study was carried out to determine whether epidural anaesthesia [EA] with dexmedetomidine sedation can be a better alternative to GA for PCNL. Aims and Objectives: To compare the efficacy and feasibility of performing PCNL under EA in combination with dexmedetomidine infusion. Methods and Material: Out of 225 patients observed in this study, 115 patients (group A) underwent PCNL under EA with dexmedetomidine infusion and 110 patients (group B) underwent PCNL under GA. Results: Mean time to the first dose of rescue analgesia was significantly increased in Epidural group (328.17 ± 63.74) compared to GA group (72.09 min, p < .0001) and the mean Visual analog scale [VAS] scores were significantly lower in epidural compared to GA group at different time intervals during the first 24 h after surgery (p<0.05). Patients in epidural group had significantly less post-operative nausea, vomiting (6.1 % vs 13.6 %), and significantly less shivering (12.2% vs 33.6%). Mean patient satisfaction score in epidural group was significantly higher (8.75 ± 1.29 vs 8.14 ± 1.39, p=0.001); however, the mean surgeon satisfaction score was comparable among the two groups (8.76 ± 1.39 in Group A and 8.61 ± 1.35 in Group B, p=0.421). Conclusions: Our study shows that EA is an equally effective alternative to GA for PCNL, with more patient satisfaction, less postoperative pain, early ambulation and postoperative recovery, less systemic analgesic requirements and less adverse effects.
