Anti-phospholipid syndrome (APS) is a systemic autoimmune acquired disease characterised by vascular thrombosis or pregnancy complications with the presence of antiphospholipid antibodies. It is a rare disease affecting 40-50/100,000 population and 10%-15% of recurrent abortions. Perioperative management in obstetric APS undergoing caesarean section stresses on the management of anticoagulation and prior choice of anaesthetic technique. We report the case of 26 year old multigravida ,37 weeks of gestation diagnosed with APS since 8 weeks of gestation. She had previous three miscarriages with lupus anticoagulant(LAC) value of 45.6 (normal – 36.8), IgM and IgG anticardiolipin antibody values were 8.5µ/ml and 3.8µ/ml, respectively. She was prophylactically put on Aspirin 75mg orally and Enoxaparin 0.4IU subcutaneously every 24 hours. She presented to the obstetric department and was planned for emergency caesarean section . She received her usual dose of enoxaparin on the day of surgery but aspirin was omitted. Surgery was conducted under subarachnoid blockade. Anticoagulation resumed 12 hours after surgery .No maternal and fetal complications were noted
Pregnancy is associated with both anatomical and physiological changes in the body, especially in cardiovascular and respiratory systems. Patients with mediastinal non-Hodgkin lymphomas are recognized to be at risk for cardiorespiratory compromise perioperatively. Here we report the anesthetic management of a 28-year-old parturient primi with 38weeks gestation came to ER with leaking per vaginum posted for emergency caesarean section. She is a known case of non-Hodgkin's lymphoma diagnosed at 3 years of age and had a relapse at 12 years for which treated with chemotherapy. Challenges in conduct of anesthesia such as systemic effects of chemotherapeutic drugs, possibility of undiagnosed mediastinal mass and relapse of the disease and concerns pertaining to emergency cesarean section were assessed and anesthesia technique is tailored according to the above-mentioned concerns.
Temporomandibular joint (TMJ) ankylosis is a restriction of movements caused by intracapsular brous adhesions, brous ankylosis and osseous ankylosis of TMJ joint. Trauma is the main cause of TMJ ankylosis. The anaesthetic management of paediatric patient with TMJ ankylosis is highly difcult task because child will be anxious with limited mouth opening. Hereby we are presenting a case of 12 year old child with TMJ Ankylosis with severely restricted mouth opening(<3mm) posted for release of the ankylotic mass with distraction osteogenesis and interpositional graft placement using dermis fat. Fiberoptic nasotracheal intubation is the gold standard method of securing airway but in resource limited setting we have described a retrograde intubation using COOK retrograde intubation set with the help of guide wire and bougie for securing airway after giving sedation with fentanyl, ketamine, transtracheal block and airway nebulisation with 4% lidocaine. Spontaneous ventilation was maintained till securing the airway. The airway was secured without any complications. Post op mouth opening was adequate, hence patient was extubated uneventfully.
INTRODUCTION Back pain is often reported as a common complaint after surgery following spinal anaesthesia. Many studies showed that the incidence of back pain after spinal anaesthesia is high and its magnitude is considerable in developing countries. It is highly related to reduced quality of life, loss of work productivity, burden of health care costs, and satisfaction regarding health care service; therefore, measures should be taken to reduce or prevent post spinal back ache. The aim of this prospective observational study is to asses the incidence of backache after spinal anaesthesia comparing gender, age and number of attempts. METHODS An institutional based prospective observational study was conducted from March to May 2022 in Saveetha Medical College Hospital, Thandalam, Chennai. A total of 100 participants were enrolled in this study. A convenience sampling technique was used to get the study participants. STATISTICAL ANALYSIS Both univariable and multivariable logistic regression were used to identify factors associated with postspinal back pain. Variables with a p value less than <0.2 in the bivariable analysis were tted into the multivariable analysis. In the multivariable analysis, a variable with a p value of <0.05 was considered statistically signicant. RESULTS The incidence of post spinal back pain was positively correlating with increase in number of attempts and increase in number of bony contacts during the spinal anaesthesia procedure and was higher in females and younger age group. DISCUSSION The overall incidence of back pain is high. Number of attempts and number of bone contacts are signicantly associated with the incidence of back pain following spinal anaesthesia. Post spinal back pain is of mild type and it manifests in rst two to six hours after surgical procedure when the local anaesthetic effect wears off. Fear of back pain in post spinal anesthesia is the main reason for patient refusal and it accounts for a rate of 13.4%. CONCLUSION This study conrms that overall incidence of backpain is high when the number of attempts, bone contacts are high .Hence, health professionals should minimize the number of attempts and bone contacts during lumbar puncture to reduce the incidence of post spinal back pain. Finally, conducting a similar study to assess the long term occurrence of postspinal back pain is recommended.
Blunt trauma to the abdomen can cause damage to vital organs like spleen, liver, kidney and intestines and is associated with high morbidity. Hereby we are presenting a case of Grade 5 Renal Injury(shattered kidney) following blunt injury abdomen. A 21 year old male presented to our Emergency Room with history of RTA. He revealed history of severe abdominal pain. He presented with severe tachycardia (HR−140⁄minute),blood pressure and saturation were normal and GCS was 15⁄15. His CECT abdomen revealed shattered left kidney with subcapsular and perinephric collection with renal vascular injury. His hemoglobin was found to be 5.7g/dl, rest of the blood investigations were within normal limits. He was shifted to OT immediately and was proceeded with open nephrectomy. Post induction he devoloped severe hypotension and was started on iv crystalloids and colloids and minimal Nor adrenaline support. Intraoperatively 4 units of PRBC and 3 units of FFP were transfused. Around 1 litre of blood, bladder clots and a concealed hematoma in messentry were evacuated. Post transfusion ABG revealed metabolic acidosis. He was shifted to ICU with the ET Tube. He made an uneventful recovery in ICU and was extubated.Physiologically, hemodynamic compensatory mechanisms maintain vital organ perfusion till about 30% TBV loss, beyond which there is a risk of critical hypoperfusion. Massive blood loss is best managed by following the massive transfusion protocol (MTP).
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