Propofol 3 mg x kg(-1) (group II) preceded by fentanyl 3 microg x kg(-1) is the optimal dose combination in our study. It provides acceptable intubating conditions in 80% patients, blunts pressor response to intubation without significant cardiovascular depression.
Awareness of the presence of thyroid function abnormalities in patients with molar pregnancy is important for its prompt diagnosis and management. We report the development of thyroid storm in the immediate post-operative period in a 25-year-old female who underwent evacuation of her molar pregnancy under saddle spinal block after being controlled for her thyrotoxicosis with a combination of antithyroid drugs, iodine, steroids and adrenergic blocking agents. We advocate the use of esmolol infusions up to a maximum dose of 200 μg/kg/min for immediate haemodynamic management of the patient. Optimum time needed for stabilisation of the hyper metabolic state after initiation of antithyroid drugs is still not known and evacuation of molar pregnancy remains the only definitive management of the thyrotoxic state.
Carcinoid tumours pose a great challenge to anaesthesiologist, especially if carcinoid syndrome is present. We report peri-operative management of a patient with carcinoid syndrome who underwent upper lobectomy. Pre-operative optimisation for 10 days before surgery with injection octreotide and administration on the day of surgery as per guidelines was followed (North American Neuroendocrine Tumour Society guidelines). Our main goals were to prevent mediator release, avoidance of triggering factors and management of peri-operative carcinoid crisis. During tumour handling patient developed carcinoid crisis which was effectively treated with intravenous bolus octreotide and increasing rate of infusion.
Giant paraesophageal hernia is an uncommon morbid disorder which may present a risk of catastrophic complications and should be repaired electively as soon as possible. Laparoscopic fundoplication is the mainstay of surgical management of this disorder due to several advantages such as lower post-operative morbidity and pain. We report a case of a 70-year-old patient with a giant paraesophageal hernia, who developed subcutaneous emphysema with pneumothorax during laparoscopic fundoplication. Early diagnosis was possible by close clinical evaluation and simultaneous monitoring of end-tidal carbon dioxide levels and airway pressures. Although positive end-expiratory pressure application is an effective way of managing pneumothorax secondary to the passage of gas into the interpleural space, insertion of an intercostal drain may be used in an emergent situation.
Background: Laryngoscopy and intubation has adverse effects like tachycardia, hypertension, myocardial ischemia and cerebral hemorrhage. There are many studies on various pharmacological agents to attenuate pressor response. Aim of the study was to compare efficacy and safety of oral clonidine versus oral pregabalin premedication to attenuate stress response in patients undergoing elective surgery.
Methods: 106 patients of American Society of Anesthesiologist (ASA) class I, aged between 18-60 years of either sex scheduled for elective surgery were randomized into two groups. Group A received oral clonidine 0.2mg and group B received oral pregabalin 150mg, 90 minutes before surgery. Primary objectives of the study heart rate(HR), systolic blood pressure(SBP) diastolic blood pressure(DBP) and mean blood pressure(MBP) were noted baseline, before induction, immediately after intubation (0) and at 1, 3, 5, 10 and 15 minutes after intubation. sedation, postoperative pain scores and any adverse effects were also noted.
Results: The demographic data were comparable in group A and group B. There was no significant difference at baseline for mean (SD) HR, SBP, DBP, and MBP in both groups (p>0.05). The mean (SD) HR was significantly lower in group A as compared to group B, before induction and at 1, 3, 5, 10 and 15 minutes (p <0.05). The mean (SD) SBP, MBP was significantly lower in group A as compared to group B, before induction immediately after intubation and at 1, 3, and 5 minutes (p <0.05). The mean (SD) DBP was significantly lower in group A as compared to group B, before induction (p 0.012). but post-operative analgesia was better in pregabalin group. Bradycardia was more in clonidine group and sedation was more with the use of pregabalin.
Conclusion: We concluded that oral premedication with either clonidine or pre.gabalin attenuates hemodynamic response to laryngoscopy and tracheal intubation, but Clonidine is superior to pregabalin.
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