Transient cortical blindness following intracardiac repair of congenital heart disease in an 11-year-old boy.

Postoperative blindness (PB) primarily involves reception and conductance parts of the visual pathway due to ischemia following cessation of blood supply, for example, retinal vascular occlusion. Although a rare cause of PB, cortical blindness (CB), which results from ischemia/infarction of visual cortex, has a poor outcome due to its mostly nonreversible nature. Ischemic optic neuropathy is the most common cause of PB following cardiac surgeries. CB following cardiac surgeries involving cardiopulmonary bypass has been rarely reported. Only a few of those articles reported partial or complete reversal of CB. We report an incidence of transient CB in an 11-year-old child who was operated for double chambered right ventricle with ventricular septal defect.

Assessment of feasibility and efficacy of Class IV laser therapy for postoperative pain relief in off-pump coronary artery bypass surgery patients: A pilot study.

BACKGROUND: Laser therapy, for its established analgesic properties with minimal side effects, has been used for the treatment of chronic pain. However, it has not been used for the treatment of acute postoperative pain. This pilot study was designed to assess the feasibility and efficacy of Class IV laser on postoperative pain relief following off-pump coronary artery bypass graft (OPCABG) surgery, as a component of multimodal analgesia (MMA) technique. METHODS: This open observational prospective study comprised of 100 adult patients (84 male, 16 female) who underwent OPCABG through sternotomy. For postoperative analgesia, they were subjected to laser therapy subjected to laser therapy in addition to the standard institutional pain management protocol comprising of IV infusion/bolus of tramadol and paracetamol and fentanyl bolus as rescue analgesic. Pain intensity was measured by Verbal Rating Scale (VRS). The laser therapy was scheduled as once a day regime for three consecutive postoperative days (PODs) starting on POD 1, 30 min following tracheal extubation. The subsequent laser applications were also scheduled at the same time of the day as on day 1 if VRS was ≥5. 10 W Class IV laser was applied over 150 cm² sternal wound area for 150 s. VRS was used to assess pain severity and was recorded for statistical analysis using Friedman Test. RESULTS: The mean (standard deviation [SD]) VRS of all the 100 patients just before application of the first dose of laser was 7.31 (0.94) while on MMT; the same fell to 4.0 (1.279) and 3.40 (2.697) at 1 h and 24 h respectively following first dose of laser. The change of VRS over first 24 h among all the 100 patients was statistically significant (P = 0.000). Laser was re-applied in 40 patients whose VRS was ≥5 (mean [SD] - 6.38 [0.868]) at 24th h. After receiving the 2nd dose of laser the VRS scores fell significantly (P = 0.000) and became 0 at 54th h. No patients required 3rd dose of the laser. No patient required rescue analgesic while on laser therapy. CONCLUSION: Class IV laser can be an effective technique for postoperative analgesia following OPCABG surgery through sternotomy when included as a component of MMA technique.

Measurement of prevalence of 'major depressive syndrome' among Indian patients attending pain clinic with chronic pain using PHQ-9 scale.

BACKGROUND: Presence of major depressive syndrome (MDS) in chronic pain patients (CPPs) requires more attention from the clinicians because of its clinical nature, association of suicidal thoughts and their actual completion, and treatment difficulties. The prevalence of MDS among Indian CPPs is not well studied. AIM: To determine the prevalence of MDS among Indian CPPs visiting pain clinic. MATERIALS AND METHODS: In this prospective study, 476 patients who attended a pain clinic in a metropolitan city of India for chronic pain (pain more than six months) were included. They were assessed by 'PHQ-9 depression scale' for presence of MDS. Intensity of pain was assessed by 'Visual analogue scale' (VAS). Patient details (viz. age, sex), duration and site of pain, and scores of PHQ-9 depression scale and VAS, were noted and statistically analyzed. RESULTS: 146 out of 476 CPPs (30.67%) were found to suffer from MDS. Women were more prone (F: M =3:2) to develop MDS while suffering from chronic pain. Among 146 CPPs who were suffering from MDS, 108 (73.97%) patients also had suicidal thought. The prevalence of suicidal thought among all CPPs was found to be 22.69%. The depression severity was found to be strongly associated with intensity of pain (P = 0.005 < 0.05) but not associated with the duration of pain (P = 0.159 > 0.05) and age of the patient (P = 0.24 > 0.05). CONCLUSION: We found a high prevalence of MDS among CPPs from India and majority of them also harbored suicidal thought. Therefore, for successful outcome in chronic pain management routine psychological assessment in CPPs should be done to exclude the presence of MDS and suicidal thought.

Anesthetic management of emergency laparotomy in a case of ischemic cardiomyopathy with COPD.

Anesthesia for non-cardiac surgeries in patients with ischemic cardiomyopathy with other co-morbidities is a challenging situation for anesthetists. The choice of anesthesia and anesthetic agents should be judicious and balanced to maintain optimum cardiac output and to avoid myocardial depression for a successful postoperative outcome. Here, we describe the anesthetic management for emergency exploratory laparotomy in a patient who was suffering from ischemic cardiomyopathy along with chronic obstructive pulmonary disease and was presented to the emergency operation theater for gastrointestinal tract perforation.

The effect of the lunar cycle on frequency of births: a retrospective observational study in Indian population.

For ancient period moon has been held responsible for many biological activities. That way, lunar cycle, by activity of moon, has been held responsible for increase in number of child birth. In this retrospective, observational study, we examined a total of 9890 full-term spontaneous deliveries as well as non-elective cesarean sections that occurred throughout 12 lunar months (February 7 th , 2008-January 25 th , 2009) in a rural medical college to evaluate the influence of the lunar position on the distribution of deliveries among Indian population. Student's 't' test and ANOVA were used for statistical analysis where each delivery was considered as a single measure. We found no significant differences in the frequency of births during various phase of lunar cycle regardless of route of delivery. Our observations do not support the hypothesis of a relationship between lunar cycle and the frequency of obstetric deliveries.

Primary hydatid cyst in gastrocnemius muscle.

Cystic echinococcosis, which is caused by the larval stages of Echinococcus granulosus, results from the presence of one or more massive cysts or hydatids, and can involve any organ, including the liver, lungs, heart, brain, kidneys, and long bones. Muscle hydatidosis is usually secondary in nature, resulting from spread of larval tissue from a primary site after spontaneous or trauma-induced cyst rupture or after release of viable parasite material during invasive treatment procedures. Primary muscle hydatidosis is extremely uncommon, because implantation at this site would require passage through the filters of the liver and lung. Intramuscular hydatid cyst can cause a variety of diagnostic problems, especially in the absence of typical radiologic findings. We present an unusual case of a primary hydatid cyst found in the popliteal fossa of the right knee of a 52-year-old woman, presenting as an enlarging soft-tissue tumor for 6 months associated with pain. The mass initially was diagnosed to be Backer's cyst by ultrasonography, but later it was confirmed postoperatively through histopathological studies to be due to hydatid disease. In regions where hydatidosis is endemic, hydatid cyst should be included in the differential diagnosis of any unusual muscular mass.

Efficacy of prophylactic intramuscular ephedrine in prevention of hypotension during caesarean section under spinal anaesthesia: a comparative study.

Hypotension during caesarean section under spinal anaesthesia is a common complication. Several measures are used to reduce the incidence of hypotension but no method is fully effective. Prophylactic intramuscular ephedrine may be effective in reducing the incidence of hypotension in addition to conventional measures. To evaluate the efficacy of prophylactic intramuscular (IM) ephedrine (0.5 mg/kg, maximum up to 45 mg), given 10 minutes and 20 minutes before spinal anaesthesia to prevent hypotension, and to observe the adverse effects of IM ephedrine. A prospective, randomised, double-blind controlled study was undertaken where 150 pregnant mothers aged between 18 and 29 years and belonging to ASA physical status I, posted for elective caesarean section, were randomly allocated into one of the three groups. Group C received only preloading with 15 ml/kg of Ringer lactate (RL) solution, group E10 and group E20 received injection ephedrine 0.5 mg/kg IM 10 minutes and 20 minutes prior to performing spinal anaesthesia respectively along with 15 ml/kg RL preloading. The incidence of hypotension was significantly more in group C compared to other two groups. Mean arterial pressure and heart rate were significantly more in group E10 compared to group C. No significant increase in the incidence of hypertension and tachycardia in any group were observed. The findings of this study indicate that prophylactic IM ephedrine 0.5 mg/kg given 10 minutes before spinal anaesthesia gives better haemodynamic stability during intra-operative period without any significant increase in the incidence of adverse effects.

Anesthetic management of a patient with sickle ß thalassemia.

Sickle cell disease is a congenital condition and its most common clinical manifestation is anemia due to chronic hemolysis. Persistent and accelerated hemolysis associated with multiple transfusions is a recognized risk factor for the development of cholelithiasis. The occurrence of gallstones is one of the most important manifestations of sickle cell disease in the digestive tract. Most gallstones are pigmented and characteristically occur at younger ages and the prevalence of cholelithiasis increases progressively with age, affecting 50% of young adults. Cholecystectomy is the most common surgical procedure performed in sickle cell disease patients. Anesthesia in this population of patients for major surgeries deserves special attention due to various complications particularly silent infarctions of end organs are common. We are reporting a 14-year-old girl diagnosed with sickle cell anemia and ß(+) thalassemia with cholelithiasis went for cholecystectomy under general anesthesia. Although the patient has both ß(+) thalassemia and sickle cell disease component, the latter is of more concern for anesthesia.

Postoperative tension pneumocephalus following cerebral aneurysm surgery in supine position without prior lumbar drainage.

The occurrence of tension pneumocephalus in neurosurgeries done in the supine position is scarcely reported. We present a case of 57-year-old man who developed tension pneumocephalus postoperatively, following cerebral aneurysm surgery, in supine position, where lumbar drainage before clipping surgery was not done. The patient's neurological status deteriorated rapidly, characterized by convulsion and unresponsiveness to external stimuli, 1 h following the uneventful surgery. Immediate computed tomography scan revealed bi-frontal tension pneumocephalus. Long duration of surgery and cerebrospinal fluid loss were assumed to be the causative factors. The patient was treated immediately with frontal drill hole evacuation for intracranial air, which saved the patient from a life threatening complication.

Two-port Laparoscopic-assisted Appendicectomy Under Local Anesthesia in Adults: A Pilot Study.

AIM: Nowadays laparoscopic-assisted appendicectomy using the two-port technique is gaining popularity due to its certain benefits over the open version. General anesthesia with positive pressure ventilation is the preferred mode of anesthesia in this technique. We conducted a pilot study using the two-port technique in adult patients, with uncomplicated appendicitis under local anesthesia, to evaluate its feasibility. MATERIALS AND METHODS: In this prospective study 12 consecutive patients of ASA grade I and II, with a mean age of 22.5 years, suffering from acute appendicitis, were included. All the patients received ondansetron, diazepam, and pentazocine as premedication. Monitored anesthesia care was given. The site of trocar insertions were infiltrated with 1% lignocaine with adrenalin. The pneumoperitoneum was created using carbon-di-oxide. After exteriorization of the appendix using the trocar, appendicectomy was performed as in the open procedure. RESULTS: Eleven out of twelve patients were successfully operated using this method without converting it into an open method. Two cases required an extra port to free the appendix from the adhesion. There were no intra- or post-operative complications present. CONCLUSION: Two-port laparoscopic-assisted appendicectomy under local anesthesia is a safe and effective method for uncomplicated appendicitis in adults, and the procedure is suitable where limited set-up for anesthesia is present.

Incidence of cardiac arrest increases with the indiscriminate use of dexmedetomidine: a case series and review of published case reports.

Dexmedetomidine has predictable, complex, and negative cardiovascular effects that lead to additional adverse effects such as bradycardia and hypotension in up to 42% of patients and might cause profound left ventricular dysfunction and refractory shock. Usually, these temporary effects can be successfully counteracted with atropine, ephedrine, and volume supplementation. Clinicians need to be well informed about the potential of dexmedetomidine to cause bradycardia, which may progress to pulseless electrical activity, particularly in patients older than 50 years and patients with cardiac abnormalities. Here, we report the clinical characteristics of six patients who were scheduled for various neurosurgical procedures within a period of three months and suffered from cardiac arrest following dexmedetomidine administration. We urge clinicians to take caution against the negative effects of dexmedetomidine, especially when it is used in patients older than 50 years with underlying cardiac disease and in combination with cardiodepressant drugs.