A 54 years old pleasant gentleman weighing about 60 Kg was admitted in NICVD with the complaint of transient ischaemic attack (T I A). He was a diagnosed case of left internal carotid artery (ICA) atherosclerotic lesion. He was hypertensive, non diabetic and non asthmatic of A.S.A grade II and scheduled for carotid endarterectomy under CEA. He was duly informed about the anaesthetic procedure during preanaesthtic check up. Patient was premedicated with tablet midazolam (7.5mg) 1 hour before arrival at OT.An 18 G epidural catheter was introduced aseptically and uneventfully at C 7 -T 1 intervertebtal space with patient in sitting position through midline approach using loss of resistance technique. Anaesthesia was induced with a mixture of 0.5% Lidocaine (5ml). 0.25% Bupivacaine (5ml) and Fentanyl citrate (50μg). After 20 minutes the onset of anaesthesia was completed and pin-prick pain sensation was abolished, Monitoring of Spo 2 , ECG, Respiration, Heart rate, Urine out put, Intraarterial blood pressure and ABG analysis etc were done. The patient received Oxygen @ 4L/ min via a nasal cannula.Surgery was conducted smoothly and uneventfully under CEA with good analgesia. Patient was awake during surgery. Total duration of surgery was 2 hours and one additional top up dose (1/3 rd of initial bolus) was given after 1 and 1/ 2 hour with intermittent propofol infusion @ 25-50μg/kg/min. Post operative recovery was smooth. Patient was started on a liquid diet and allowed to mobilize 4 hours after surgery. Post operative analgesia was maintained with 0.125% Bupivacaine (4 ml) with Fentanyl citrate 2μg/ml through epidural catheter 6 hourly or earlier if the patient complains of pain. No other rescue analgesia was required. Discussion:Carotid endarterectomy can be performed under general or regional anaesthesia. Regional anaesthesia may be either cervical plexus block or cervical epidural anaesthsia. Regional anaesthesia is more cost-effective, given that less intensive care and shorter hospital stays are required. 2 GA is the conventional method, CEA is practiced less often because of the fear of potential complication. Cervical plexus block is an alternative for CEA but this may be incomplete, surgery cannot be prolonged, and post operative analgesia is not possible. Monitoring of cerebral function is difficult under GA. By contrast, continuous monitoring of awareness and neurological deficit and hence adequacy of cerebral perfusion is possible under regional anaesthesia. 3 This however can become a disadvantage if the patient develops cerebral ischaemia which may lead to disorientation, Cervical Epidural Anesthesia for Carotid Endarterectomy
Ten patients with life threatening ventricular arrhythmias who underwent placement of automatic cardioverter defibrillator ( AICD) under conscious sedation are reported. Our clinical experience, patient,s satisfaction, recovery profile and complications of the technique of conscious sedation is presented and discussed. Key words: Ventricular dysrhythmias; Autamatic implantable cardioverter defibrillator; Conscious sedation DOI: http://dx.doi.org/10.3329/cardio.v4i1.9388 Cardiovasc. J. 2011; 4(1): 42-45
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