Meningoencephalocele is herniation of cerebrospinal fluid, brain tissue and meninges through the skull defect. The anaesthetic management of occipital meningoencephalocele is challenging because of the difficulty in securing airway, prone position, blood loss and, perioperative care. The two major aims of the anaesthesiologists while caring for children with occipital encephalocoele intraoperatively are to avoid premature rupture of the encephalocoele and to manage a possible difficult airway due to restricted neck movement and inability to achieve optimal position for intubation of the trachea. We report a case of giant occipital meningoencephalocele presented for surgical excision. Perioperative management of patients with giant meningoencephalocele may be challenging for both anaesthesiologist and neurosurgeon. These patients must be managed closely with an interdisciplinary approach.
Meningoencephalocele is herniation of cerebrospinal fluid, brain tissue and meninges through the skull defect. The anaesthetic management of occipital meningoencephalocele is challenging because of the difficulty in securing airway, prone position, blood loss and, perioperative care. The two major aims of the anaesthesiologists while caring for children with occipital encephalocoele intraoperatively are to avoid premature rupture of the encephalocoele and to manage a possible difficult airway due to restricted neck movement and inability to achieve optimal position for intubation of the trachea. We report a case of giant occipital meningoencephalocele presented for surgical excision. Perioperative management of patients with giant meningoencephalocele may be challenging for both anaesthesiologist and neurosurgeon. These patients must be managed closely with an interdisciplinary approach.
Background: Levobupivacaine has been purported to be as efficacious as Bupivacaine for epidural anaesthesia in recent literature.Methods: With the intent to study the same in caesarean section cases in our set up, we observed various intra- and post-operative variables in two groups (Levobupivacaine and Bupivacaine) of 60 healthy parturients. Sixty parturients for elective caesarean section were allocated randomly to receive epidural block with 10-20 ml of either 0.5% Levobupivacaine with Fentanyl 25µg or 0.5% Bupivacaine with Fentanyl 25µg to reach T6 level.Results: Mean total volume in Bupivacaine group was 15.23ml and in Levobupivacaine group was 12.76 ml. The difference was statistically significant. There was significant difference between the groups in the sensory block. The onset of analgesia was earlier in Levobupivacaine group. Mean time was 6.20 minutes in Bupivacaine group and 4.36 minutes in Levobupivacaine group. The duration of motor block was significantly short in Levobupivacaine group. Mean Time for recovery from motor block in Bupivacaine group was 2.5 hours and in Levobupivacaine group 1.5 hours. Mean time to achieve T6 height was earlier in Levobupivacaine group i.e. 16.46 minutes in Bupivacaine group and 13.26 minutes in Levobupivacaine group. Duration of postoperative analgesia was similar. There was no significant difference in neonatal outcome.Conclusions: Levobupivacaine was found to fare better than Bupivacaine in the studied intra and post-operative parameters and is hence recommended over racemic Bupivacaine for epidural block in patients undergoing elective cesarean section.
Laryngoscopy and tracheal intubation causes intense autonomic reflex responses such as tachycardia, hypertension and a rise in intraocular pressure (IOP). Rise in IOP is further compounded by the use of succinylcholine. Various drugs used to attenuate the rise in IOP are pretreatment with non-depolarizing muscle relaxant, lignocaine, narcotics, nifedipine and nitroglycerine, but none is found to abolish it completely. To obtain haemodynamic response lignicaine, opiods, nitroprusside, nitroglycerine, vearpamil, nifedipine, esmolol, clonidine etc. have been used. AIMS AND OBJECTIVES: We investigated whether dexmedetomidine an α2 agonist could attenuate the rise in IOP after succinylcholine and intubation. Simultaneously, its effect on attenuation of haemodynamic response (Heart rate and MAP) to laryngoscopy and intubation was also evaluated. MATERIALS AND METHODS: Eighty patients without pre-existing eye disease undergoing general anesthesia was randomly premedicated by iv dexmedetomidine 0.6µg or saline. Heart rate (HR), mean arterial pressure (MAP), IOP (using Schioetz tonometer) was measured before, after the premedication, after thiopental, after succinylcholine, immediately after intubation and then every minute for 3 minutes. Statistical Analysis: descriptive and inferential statics using chi-square test, z-test and Wilcoxon sign rank test was done. Software used in the analysis was SPSS 17.0 version and Graph Pad Prism 5.0. Data was reported as mean value ± SD & p-value < 0.05 was considered as level of significance. RESULTS: Succinylcholine and intubation increased IOP in both the groups. However, in the dexmedetomidine group, it was not significantly different from baseline values (z value=0. 93, p=0. 358) and was significantly lower than in the control group (z =6. 644, p=0. 000). After intubation the MAP in the control group (z=17. 4, p=0. 000) was higher than that in the dexmedetomidine group (z=8, p=0. 000) and exceeded the baseline value (p<0.05). The heart rate also showed a less fluctuation in the dexmedetomidine group than in the control group. (z=7. 73, p<0.05 after succinylcholine and z=9. 22, p<0.05 after intubation) CONCLUSION: IV dexmedetomidine 0.6µg premedication is advantageous as it is found to be effective in reducing the rise in IOP. It is also beneficial in attenuating the haemodynamic response of succinylcholine, laryngoscopy and intubation to prevent its consequences.
Congenitally corrected transposition of the great arteries (CCTGA) is a rare form of congenital heart diseases, present with or without associated anomalies. It is a complex congenital heart disease with both atrioventricular and ventriculoarterial discordance. Such patients tend to develop systemic ventricular dysfuction with the stress of surgery. Patients with CCTGA are usually diagnosed at early stages of life due to associated anomalies, but they may even remain asymptomatic till later decades of their life. Literature search revealed very few reported cases of anaesthetic management of such high risk cases for non cardiac surgery. These patients have the tendency to develop cardiac dysrhythmias and left ventricular failure during intraoperative and postoperative period. We report anaesthetic management of a case of a 24 years old male with the congenitally corrected transposition of great arteries(CCTGA) who was operated for fracture left distal radius and ulna and right sided galeazzi fracture.
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