BACKGROUNDThe introduction of local anaesthetic solutions into subarachnoid space produces Spinal Anaesthesia (SA). Spinal anaesthesia can be used either alternative to the general anaesthesia or can be used simultaneously with general anaesthesia or afterwards for postoperative analgesia and for the management of acute and chronic pain disorder.
Objective To determine the safety of elective open tracheostomy as a routine intensive care unit (ICU) procedure without any selection criteria, considering its peri-and postoperative complications.Materials and methods This is a descriptive study conducted in two hospitals in Davangere for a period of three years between April 2005 and March 2008. 40 patients, both male and female, of all age groups who were under mechanical ventilation in whom open tracheostomy was performed were included in the study. All patients who recovered were followed-up for two months. Complications arising during this period were recorded in the proforma.Results Our study consisted of 40 patients comprising 30 males and 10 females with male to female ratio of 3:1 and average age of 35 years, all undergoing open tracheostomy for prolonged mechanical ventilation. Various indications for mechanical ventilation included polytrauma, head injury, septicemia with multiorgan failure and dengue encephalitis. The complications which arised during the procedure and follow-up period included cardiac arrest, surgical emphysema, reactionary hemorrhage, pneumothorax, tracheocutaneous fi stula, tracheo-oesophageal fi stula.
ConclusionElective open tracheostomy seems to be a safe and simple procedure, when performed by experienced surgeon under controlled circumstances, and should be considered as an option for mechanically ventilated patients.
Anesthetic management of pheochromocytoma is complicated and challenging. Extra-adrenal pheochromocytoma is a rare neuroendocrine tumor that produces, stores and secretes catecholamines. The main-stay in the management of pheochromocytoma surgeries is Preoperative preparation which has improved perioperative outcome. Modern anesthetic drugs with advanced monitoring have contributed to intraoperative stability. Resection of the tumor results in acute withdrawal of catecholamines, which may lead to severe hypotension. In perioperative period, adequate hydration should be maintained. Beta-blockers, nitroglycerine, sodium nitroprusside and phenylephrine are required to avoid hemodynamic fluctuations and should be used appropriately.
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