Aim: Epidural anaesthesia which is preferred in most of the prolonged and painful procedures can be dreadful when the catheter breaks inside. In this case report we report accidental breakage of epidural catheter and its successful management.
Presentation of Case: 47 year old male patient was posted for arthroscopic Anterior cruciate ligament (ACL) and Posterior Cruciate Ligament (PCL) repair under spinal and epidural anesthesia. Epidural catheter got sheared while securing it. It was managed by surgical removal to avoid further complications.
Discussion: There are different causes for epidural catheter breakage including technical error and manufacture error. Catheter should be checked for any manufacturing defect or kinking. If there is resistant while inserting the catheter careful removal of catheter along with the needle should be performed to avoid breakage of catheter.
Conclusion: Epidural catheter breakage can be disastrous for any anaesthesiologist, so it is important to be vigilant while securing epidural catheter. If accidentally epidural catheter is retained it should be discussed with the patient and surgeons, and it is either removed since it is a foreign body or if left in situ. Serial follow-up for any neurological symptoms should be done.
Complex regional pain syndrome which is a rare syndrome following an injury or trauma, is an extremely painful condition. Diagnosis of this condition is not easy. They present with various symptoms like allodynia, hyperalgesia, asymmetry of temperature and sweating ,restricted range of motion. Identifying and treating this condition at earlier stage is important. There are different treatment options like pharmacological (NSAIDs, Anticonvulsants, Antidepressants, neuromodulators) and interventional techniques like Stellate ganglion block, Thoracic Sympathetic Ganglion block, Lumbar sympathetic block, Neurostimulation.
In this case report we present a case of 52 year old female post mastectomy and radiation therapy developing CRPS of left upper limb, which was diagnosed and managed successfully with diagnostic thoracic sympathetic ganglion block followed by therapeutic radiofrequency ablation.
Takayasu's arteritis (TA) is a chronic inflammatory illness of the major arteries that is extremely rare. It mainly affects women of reproductive age which increases the risk of cardiovascular problems such hypertension and congestive heart failure. In this study, we discuss the case of a pregnant woman with TA who was diagnosed and managed successfully at a tertiary care facility with a good outcome. As a result, comprehensive care for TA patients has been shown to be critical in achieving optimal maternal and fetal/neonatal outcomes.
BACKGROUND The perioperative habits contemplate showing that kids are in more danger of encountering fierce sedative enlistment and unfriendly social sequelae. In paediatric sedation, decent premedication is fundamental to lessen tension and disturbance in youngsters. Parental partition and odd operating room environment as a rule bring about blustery acceptance while giving general sedation. Narcotic premedication is vital for making kids quiet and cooperative in a weird environment. Our study was done to compare the efficacy of midazolam 0.5 mg / kg and triclofos sodium 100 mg / kg as oral premedications in children undergoing elective surgery. METHODS In this prospective randomised comparative study, sixty children posted for elective surgery were enrolled. The patients were randomly divided into midazolam group (Group M) and triclofos sodium group (Group T) of thirty each. Group M received oral midazolam 0.5 mg / kg 30 min before induction, and Group T received oral triclofos sodium 100 mg / kg 60 min before induction. All children were evaluated for level of sedation after premedication, behaviour at the time of separation from parents and at the time of mask placement for induction of anaesthesia. RESULTS Oral midazolam showed satisfactory sedation in children after premedication when compared to oral triclofos (P = 0.003). Both the drugs had a successful separation from parents, and the children were very cooperative during induction. No adverse effects attributable to the premedicants were seen. CONCLUSIONS Oral midazolam is better than triclofos sodium as a sedative anxiolytic in the paediatric population. KEY WORDS Anaesthesia, Hypnotics and Sedatives, Midazolam, Paediatrics, Premedication, Triclofos sodium
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