Unusual Presentation of Myasthenia Crisis Following Thymectomy and Thyroidectomy.

Respiratory distress after thyroidectomy and thymectomy can be challenging. We encountered a 70-year-old lady with a long-standing goiter with concomitant thymoma. She underwent the surgery and developed respiratory distress upon extubation with loss of laryngeal sensation causing severe aspiration. She was diagnosed myasthenia gravis and symptoms resolved with MG treatments.

The comparison between propofol and dexmedetomidine infusion on perioperative anxiety during regional anesthesia

Background/aim: Regional anesthesia for surgery is associated with increased anxiety for patients. This study aimed to compare the effect of propofol and dexmedetomidine infusion on perioperative anxiety during regional anesthesia. Materials and methods: Eighty-four patients were randomly divided into two groups receiving either study drug infusion. Anxiety score, level of sedation using the Bispectral Index and Observer's Assessment of Alertness and Sedation, hemodynamic stability, and overall patient's feedback on anxiolysis were assessed. Results: Both groups showed a significant drop in mean anxiety score at 10 and 30 min after starting surgery. Difference in median anxiety scores showed a significant reduction in anxiety score at the end of the surgery in the dexmedetomidine group compared to the propofol group. Dexmedetomidine and propofol showed a significant drop in mean arterial pressure in the first 30 min and first 10 min respectively. Both drugs demonstrated a significant drop in heart rate in the first 20 min from baseline after starting the drug infusion. Patients in the dexmedetomidine group (76.20%) expressed statistically excellent feedback on anxiolysis compared to patients in the propofol group (45.20%). Conclusion: Dexmedetomidine infusion was found to significantly reduce anxiety levels at the end of surgery compared to propofol during regional anesthesia.

Comparing insertion characteristics on nasogastric tube placement by using GlideScopeTM visualization vs. MacIntosh laryngoscope assistance in anaesthetized and intubated patients / Comparação das características de inserção de sonda nasogástrica, usando visibilização pelo laringoscópio GlideScope® vs. guiada pelo laringoscópio MacIntosh em pacientes anestesiados e intubados

Abstract Background and objective: This was a prospective, randomized clinical study to compare the success rate of nasogastric tube insertion by using GlideScopeTM visualization versus direct MacIntosh laryngoscope assistance in anesthetized and intubated patients. Methods: Ninety-six ASA I or II patients, aged 18-70 years were recruited and randomized into two groups using either technique. The time taken from insertion of the nasogastric tube from the nostril until the calculated length of tube had been inserted was recorded. The success rate of nasogastric tube insertion was evaluated in terms of successful insertion in the first attempt. Complications associated with the insertion techniques were recorded. Results: The results showed success rates of 74.5% in the GlideScopeTM Group as compared to 58.3% in the MacIntosh Group (p = 0.10). For the failed attempts, the nasogastric tube was successfully inserted in all cases using rescue techniques. The duration taken in the first attempt for both techniques was not statistically significant; Group A was 17.2 ± 9.3 s as compared to Group B, with a duration of 18.9 ± 13.0 s (p = 0.57). A total of 33 patients developed complications during insertion of the nasogastric tube, 39.4% in Group A and 60.6% in Group B (p = 0.15). The most common complications, which occurred, were coiling, followed by bleeding and kinking. Conclusion: This study showed that using the GlideScopeTM to facilitate nasogastric tube insertion was comparable to the use of the MacIntosh laryngoscope in terms of successful rate of insertion and complications.

Resumo Justificativa e objetivo: Este foi um estudo clínico prospectivo e randômico para comparar a taxa de sucesso da inserção de sonda nasogástrica (NG) com as técnicas de visibilização guiada pelo laringoscópio GlideScope® versus guiada pelo laringoscópio MacIntosh em pacientes anestesiados e intubados. Métodos: Foram recrutados 96, ASA I ou II, entre 18-70 anos, e divididos randomicamente em dois grupos, com uma ou outra técnica. Foi calculado o tempo transcorrido desde a inserção da sonda NG, da narina até a inserção do comprimento calculado da sonda. A taxa de sucesso de inserção da sonda NG foi avaliada quanto à inserção bem-sucedida na primeira tentativa. As complicações associadas às técnicas de inserção foram registradas. Resultados: Os resultados mostraram taxas de sucesso de 74,5% para o grupo GlideScope® em comparação com 58,3% para o grupo MacIntosh (p = 0,10). Para as tentativas que falharam, a sonda NG foi inserida com sucesso em todos os casos, com as técnicas de resgate. A duração da primeira tentativa para ambas as técnicas não foi estatisticamente significativa: 17,2 ± 9,3 segundos no Grupo A e 18,9 ± 13,0 segundos no Grupo B (p = 0,57). No total, 33 pacientes desenvolveram complicações durante a inserção da sonda NG: 39,4% no Grupo A e 60,6% no Grupo B (p = 0,15). As complicações mais comuns ocorridas foram enrolamento, seguido de sangramento e dobradura. Conclusão: Este estudo mostrou que o uso do GlideScope® para facilitar a inserção de sonda nasogástrica foi comparável ao uso do laringoscópio MacIntosh quanto à taxa de sucesso de inserção e às complicações.

Comparing insertion characteristics on nasogastric tube placement by using GlideScope™ visualization vs. MacIntosh laryngoscope assistance in anaesthetized and intubated patients.

BACKGROUND AND OBJECTIVE: This was a prospective, randomized clinical study to compare the success rate of nasogastric tube insertion by using GlideScope™ visualization versus direct MacIntosh laryngoscope assistance in anesthetized and intubated patients. METHODS: Ninety-six ASA I or II patients, aged 18-70 years were recruited and randomized into two groups using either technique. The time taken from insertion of the nasogastric tube from the nostril until the calculated length of tube had been inserted was recorded. The success rate of nasogastric tube insertion was evaluated in terms of successful insertion in the first attempt. Complications associated with the insertion techniques were recorded. RESULTS: The results showed success rates of 74.5% in the GlideScope™ Group as compared to 58.3% in the MacIntosh Group (p=0.10). For the failed attempts, the nasogastric tube was successfully inserted in all cases using rescue techniques. The duration taken in the first attempt for both techniques was not statistically significant; Group A was 17.2±9.3s as compared to Group B, with a duration of 18.9±13.0s (p=0.57). A total of 33 patients developed complications during insertion of the nasogastric tube, 39.4% in Group A and 60.6% in Group B (p=0.15). The most common complications, which occurred, were coiling, followed by bleeding and kinking. CONCLUSION: This study showed that using the GlideScope™ to facilitate nasogastric tube insertion was comparable to the use of the MacIntosh laryngoscope in terms of successful rate of insertion and complications.

[Comparing insertion characteristics on nasogastric tube placement by using GlideScope™ visualization vs. MacIntosh laryngoscope assistance in anaesthetized and intubated patients]. / Comparação das características de inserção de sonda nasogástrica, usando visibilização pelo laringoscópio GlideScope(®) vs. guiada pelo laringoscópio MacIntosh em pacientes anestesiados e intubados.

BACKGROUND AND OBJECTIVE: This was a prospective, randomized clinical study to compare the success rate of nasogastric tube insertion by using GlideScope™ visualization versus direct MacIntosh laryngoscope assistance in anesthetized and intubated patients. METHODS: Ninety-six ASA I or II patients, aged 18-70 years were recruited and randomized into two groups using either technique. The time taken from insertion of the nasogastric tube from the nostril until the calculated length of tube had been inserted was recorded. The success rate of nasogastric tube insertion was evaluated in terms of successful insertion in the first attempt. Complications associated with the insertion techniques were recorded. RESULTS: The results showed success rates of 74.5% in the GlideScope™ Group as compared to 58.3% in the MacIntosh Group (p=0.10). For the failed attempts, the nasogastric tube was successfully inserted in all cases using rescue techniques. The duration taken in the first attempt for both techniques was not statistically significant; Group A was 17.2±9.3s as compared to Group B, with a duration of 18.9±13.0s (p=0.57). A total of 33 patients developed complications during insertion of the nasogastric tube, 39.4% in Group A and 60.6% in Group B (p=0.15). The most common complications, which occurred, were coiling, followed by bleeding and kinking. CONCLUSION: This study showed that using the GlideScope™ to facilitate nasogastric tube insertion was comparable to the use of the MacIntosh laryngoscope in terms of successful rate of insertion and complications.

Primary cutaneous anaplastic large cell lymphoma with lung metastasis

Primary cutaneous anaplastic large cell lymphoma (PC-ALCL) is relatively a rare tumour of head and neck region. Without histopathological confirmation, it appears and behaved as like malignant epithelial tumor of the head and neck region as will be illustrated in the present case. Cutaneous involvement of the tumor with distant metastasis has made the prognosis unfavorable. This isolated case of head and neck PC-ALCL was highlighted as it has a tendency to behave aggressively and early diagnosis and treatment is crucial to avoid poor survival outcome.