Background
Tuberous sclerosis is an autosomal dominant neurocutaneous disorder characterized by hamartoma formation in various organ systems leading to highly variable clinical presentation. These patients pose a challenge to anesthesiologists due to multisystem involvement.
Case presentation
Herein, we report the successful anesthetic management of a 25-year-old parturient with tuberous sclerosis who underwent an emergency cesarean section in view of cephalopelvic disproportion. She had a seizure disorder, bilateral renal angiomyolipomas, angiofibroma over the cheeks, periungual fibroma on the right toe, and nodular lesions near the base of the tongue and oropharynx. We opted for regional anesthesia to avoid airway instrumentation, drug interaction, and renal insult.
Conclusions
Anesthetic management of tuberous sclerosis depends upon the extent and severity of the involvement of various organs. Careful assessment, thorough evaluation, and preoperative planning are crucial for dealing with the difficulties and complications encountered during the management of these cases.
Introduction: Haemodynamic stress response to direct laryngoscopy and endotracheal intubation have been well established. Both gabapentin and esmolol facilitates in attenuating this stress response through different mechanisms. Aim: To compare the efficacy of gabapentin and esmolol in reducing the haemodynamic stress response to laryngoscopy and intubation. Materials and Methods: The present single centre, randomised clinical trial was conducted at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from May 2022 to August 2022 among 90 American Society of Anesthesiologists (ASA) I and II patients. The patients were divided into two groups, group G and group E. In group G, tablet gabapentin 800 mg given three hours before surgery while injection normal saline 10 mL intravenously was given two minutes prior to induction. Group E received tablet placebo three hours before surgery and injection esmolol 1.5 mg/kg diluted upto 10 mL was given intravenously two minutes prior to induction. The baseline Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) and the change at 1, 2, 5 and 10 minutes after laryngoscopy and intubation was observed. Comparison of continuous variables between two groups was done using independent t-test and comparison of percentages between two or more groups was done using Chi-square test. Results: The mean age of group G and group E was 41.52±9.87 years and 38.54±10.06 years, respectively. Male to female ratio in group G and group E was 20:25 and 21:24, respectively. There was no significant difference in haemodynamic response to intubation between both gabapentin group and esmolol group. However, the esmolol group had more falls in all haemodynamic parameters such as HR, SBP, DBP and MAP (<20%) intraoperatively. Conclusion: Both esmolol and gabapentin were effective in attenuating the stress response to laryngoscopy and endotracheal intubation when used as premedication. But there was more decrease in HR and blood pressure intraoperatively, when injection esmolol was used.
Ischemic heart disease (IHD), also known as coronary artery disease, occurs due to the blockage of coronary arteries which reduces the blood supply of the myocardium. The main goal of the anesthetic management of IHD patients undergoing non-cardiac surgery is to maintain the balance between myocardial oxygen supply and demand. Here, we report the anesthetic management of an IHD patient with a low ejection fraction who was posted for percutaneous nephrolithotomy in the prone position. We opted for graded epidural anesthesia with a low dose of a local anesthetic drug and opioid. Graded epidural anesthesia is a safe alternative over general anesthesia for patients with IHD and low ejection fraction as it reduces stress response to surgery, provides good postoperative analgesia, and avoids myocardial depressant drugs and coagulation responses.
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