Anaesthetic implications of a case of hyperthyroidism detected during the closure of an atrial septal defect.

A woman in her mid-20s who was clinically euthyroid presented with an ostium secondum atrial septal defect for closure. Preoperatively, heart rate ranged from 80 to 110 beats per minute. On the day of surgery, heart rate was 120 beats per minute, which settled after induction. During ultrasound guided central line access, a thyroid swelling was noticed. 20-30 min after commencement of the surgery, heart rate increased up to 130 beats per minute. Since other causes of tachycardia was ruled out, an intraoperative blood sample for thyroid function test was sent. Esmolol was kept ready in case the swelling turned out to be hyperfunctioning thyroid nodule. Post bypass, the patient again developed tachycardia. The thyroid function test showed elevated T3, T4 and a mildly elevated TSH (Thyroid stimulating hormone) value, consistent with an extrathyroid source. The patient is on long-term follow-up under an endocrinologist. Postoperatively, she is again euthyroid and heart rates have settled to less than 100 beats per minute.

Correlation between depth of subarachnoid space in the lumbar region estimated by Stocker's formula, ultrasound, and depth of needle insertion: A prospective observational study.

Background and Aims: The main challenge in administration of spinal anesthesia in patients is the unpredictability of the exact skin to subarachnoid space depth (SSD). Approximation of SSD and needle length comes at the expense of patient comfort and multiple attempts increases complications. Our study aimed to evaluate the validity of Stocker's formula to estimate SSD in comparison to ultrasonography and depth of needle insertion. We also aimed to determine an equation to describe the relationship between patient weight and SSD in an Indian population. Material and Methods: This was a prospective observational study. A total of 234 adults of American Society of Anesthesiologists (ASA) category 1 and 2 were selected for the study. The patients underwent spinal anaesthesia and SSD data were determined using weight-based Stocker's formula (DS), ultrasonography (DU), and actual depth of needle insertion (DA). Correlation analysis was performed to determine variables that can predict the SSD. A linear regression was calculated to describe the relationship between patient weight and SSD. SSD data were determined using weight-based Stocker's formula ultrasonography, and actual depth of needle insertion. Results: Mean SSD using Stocker's formula, ultrasonography, and actual depth of needle insertion was 4.92 ± 0.6 cm, 4.47 ± 0.6 cm, and 4.81 ± 0.6 cm. Our study showed a significant correlation between Stocker's formula and SSD measured by actual depth of needle insertion (R 2 = 0.376). This was described by the derived formula: SSD (cm) =2.522+ [0.031 × weight (kg)]. Conclusion: SSD correlates well with the weight of adult patients. Measurement with Stocker's formula and actual depth showed better correlation than Stocker's formula and ultrasonography. This is valuable in resource-poor areas with a lack of ultrasound machines or expertise in training.

Comparision of Ambu AuraGain™ and LMA® ProSeal in children under controlled ventilation.

BACKGROUND AND AIMS: The LMA ProSeal® is considered a prototype among the second-generation supraglottic airway devices (SAD). The Ambu AuraGain™ is a relatively new, single use, second-generation SAD with a preformed shape. We conducted this study with the aim of comparing the difference in clinical performance between Ambu AuraGain™ and LMA ProSeal® in children receiving controlled ventilation. METHODS: Ninety-four children, aged between 6 months to 12 years, weighing 5 to 30 kg, belonging to American Society of Anesthesiologists Physical Status I and II, undergoing elective surgical procedures, were randomized into two groups. The primary end-point was oropharyngeal seal pressure, and the secondary parameters were the number of attempts, time of insertion, ease of placement of the device and gastric tube, and fiberoptic visualization of the laryngeal aperture. RESULTS: The mean oropharyngeal seal pressure with Ambu AuraGain™ was significantly higher than LMA ProSeal® (23.3 ± 4.6 cmH2O vs 20.6 ± 4.8 cmH2O, P = 0.007, respectively). The ease and success rate for device placement, fiberoptic visualization of the larynx, and complications were comparable. However, the time for insertion in Ambu AuraGain™ group was shorter when compared to LMA ProSeal® group, median (IQR [range]); 12 (10-15) s vs 20 (18-23) s (P < 0.001), respectively. The gastric drain was significantly easier to insert in Ambu AuraGain™ compared to LMA® ProSeal (P = 0.01). CONCLUSION: Our study suggests that Ambu AuraGain™ could be a useful disposable alternative to LMA ProSeal® for securing airway in children.

Anaesthetic Implications of Severe Hyperthyroidism Secondary to Molar Pregnancy: A Case Report and Review of Literature.

Pregnant women with gestational trophoblastic disease have an increased likelihood to develop hyperthyroidism secondary to increased secretion of human chorionic gonadotropin. Most of these cases of hyperthyroidism remain undiagnosed and may present as a thyrotoxic crisis during the perioperative period. Pregnant patients with gestational trophoblastic disease should be always evaluated for hyperthyroidism, and in cases of severe hyperthyroidism, antithyroid treatment should be initiated before evacuation of the mole. Anesthetic management of these cases is challenging in view of the emergency nature of the surgery and potential for thyroid crisis. Spinal anesthesia can be safely administered and has a protective role in preventing thyroid crisis.