The incidence of breast carcinoma is on the rise in Asian countries like India and pulmonary tuberculosis is one of the most common infectious diseases encountered here. Although coexistence of active pulmonary tuberculosis and breast cancer in same patient is rare, it poses a huge challenge to the anaesthetist when patients having the above conditions concomitantly are posted for surgeries like mastectomy. Here we report the anaesthetic management of a case of breast carcinoma with active pulmonary tuberculosis managed successfully under thoracic epidural anaesthesia chosen to avoid major hemodynamic, respiratory and other complications like operation theatre pollution and drug interactions between anti tubercular and anticancer drugs and drugs used for general anesthesia.
The Anaesthetic management of patients with post burn contracture release poses many problems to anaesthesiologist. Airway management in such cases is still challenging to anaesthesiologist as the contracture and deformity due to fibrous tissue resulting in non-alignment of oral, pharyngeal and laryngeal planes, makes laryngoscopy and endotracheal intubation very difficult or impossible and this can result in many life threatening and serious complications. We report the successful airway management of a patient with restricted neck extension and fixed flexion deformity by awake nasal fibreoptic bronchoscope guided nasotracheal intubation.
ASD one of the most common acyanotic congenital heart disease in women of child bearing age and pregnancy, it accounts for about 10% of all congenital heart disease. During pregnancy ASD is usually well tolerated. Bronchial asthma can complicate 1-7% of pregnancies. Uncontrolled asthma may produce serious maternal and fetal complications like PAH, fetal hypoxemia. These patients are considered to have high risk for anaesthesia due to increased perioperative cardiovascular and pulmonary complications. During anaesthesia our objectives are to avoid hypotension, hypoxemia, reversal of shunt and fluid overload. Here we report the successful management of a parturient with ASD, mild PAH with bronchial asthma posted for emergency caesarean section, managed under sub-arachnoid block.
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