Transforaminal sacral approach for spinal anesthesia in orthopedic surgery: A novel approach.

Regional anesthesia is preferred world-wide for its distinct advantages. The benefits of regional anesthesia in patients with comorbid conditions are well-established. The administration of regional anesthesia can sometimes pose a challenge to the anesthesiologist due to the structural abnormalities of the spine. The most common difficulty encountered for spinal anesthesia in our hospital (Nalgonda District) is skeletal fluorosis. Apart from the midline approach, paramedian, and Taylor's approaches are advocated for difficult scenarios. This article reports two orthopedic cases, conducted under a novel spinal anesthesia technique, i.e., transforaminal sacral approach under C-arm guidance with a successful outcome. The sacral foraminal subarachnoid block is a method to access the subarachnoid space through the upper posterior sacral foramina.

MILITANCY TRAUMA : PENETRATING AND NONPENETRATING CARDIAC INJURY.

Two hundred and eighty patients with serious chest injuries were treated at a service hospital during a period of 41 months. Out of 9 patients who suffered cardiac trauma S had penetrating cardiac injuries, 2 had penetrating pericardial injury and 2 patients had myocardial contusions. Myocardial contusions simulated myocardial infarction. All patients except one had polytrauma, associated injury to the lung or intra-abdominal organs. Early evacuation, resuscitation, high index of suspicion for cardiac injury and prompt surgical intervention were the keys to successful management in these patients. Thoracotomy was performed to repair the myocardial perforation and lacerated lung injuries. Associated infra-abdominal injuries were managed with laparotomy. Two patients died due to lack of cardiopulmonary bypass facilities and resistant cardiac arrhythmias. Seven patients had uneventful recovery.

MILITANCY TRAUMA : ANAESTHESIA AND CRITICAL CARE MANAGEMENT.

At a Base Hospital, 2151 patients of militancy trauma were managed from Jan 1990 to 31 May 1993. It involved military, paramilitary, ex-servicemen, civilians, foreigners and antinational elements. The nature of trauma was either gun shot wounds (1333) or blast injuries (818). Polytrauma (multiple injury to soft tissue, hone, parenchyma with shock or injury to more than one body region) was seen in 862 patients. Standard protocol was evolved for initial management in ICU/acute surgical ward. Time taken for initial evaluation of injury, resuscitation, respiratory care and oxygen therapy, analgesics, blood group cross matching, antibiotics and preparation of the part before surgery was usually 45 min. Anaesthesia was induced with ketamine 2 mg/kg or thiopentone 3 mg/kg based on haemodynaemic response and maintained with N2O : O2 (50 : 50 ratio), relaxant controlled ventilation. Mortality was 3.8% including 4 deaths on operation table.