Diagnostic laparoscopy has been performed ever since inter ests in infertility and fertility have developed. Methylene blue is administered to check tubal patency during the procedure. Extravasation of methylene blue is a recognized complication of diagnostic laparoscopy and chromopertubation. Anaphy laxis and anaphylactic reactions in the perioperative period are a significant concern for surgeons and anesthesiologists. The incidence is as high as 1 in 3,500 with a mortality rate of 3 to 6%. 16 There are no relevant literature or research article that provides sufficient data or guidelines for determining the nature of these reactions, mode of treatment algorithm, or the certain specifications we should consider before performing the procedure. This is a review literature for performing a safe practice evaluation and management.
Goldman and colleagues identified severe aortic stenosis (AS) as a risk factor for perioperative cardiac complications in non-cardiac surgery. Although patients with aortic stenosis are at an increased risk of perioperative cardiac events, they can undergo non-cardiac surgery relatively safely provided that the condition is recognized and appropriate monitoring and management put in place. The early detection and treatment of hypotension and arrhythmias are essential. We present a case of severe aortic stenosis posted for emergency open cholecystectomy which was successfully managed under epidural anaesthesia and had an uneventful recovery.
Doukky Rand colleagues acknowledged that Transcutaneous Cardiac Pacing is a temporary method of pacing which may be indicated in patients with symptoms of severe or hemodynamically unstable bradyarrhythmias. It is found to be extremely helpful in patients with reversible or transient conditions, such as digoxin toxicity and in atrioventricular block in the case of inferior wall myocardial infarction, or when transvenous pacing is not available or there are high chances of complications. Widened QRS complex indicates successful attempt followed by a distinct ST segment and broad T wave. The hemodynamic response to pacing is to be confirmed by the assessment of patient’s arterial pulse waveforms. Trancutaneous pacing is a boon to manage and treat intra op dangerous bradycardia.
Patients diseased with gynecological malignancies were believed untreatable with poor survival chances till hyperthermic intraperitoneal chemotherapy after capital cytoreductive surgery came into existence. Perioperative management of this patient, for a major surgery like CRS/HIPEC is complex and challenging. Major perioperative concerns in these patients include anesthetic challenges intraoperative fluid management, maintaining mean arterial blood pressure, thermoregulation electrolyte imbalances, significant blood loss and fluid shifts and renal toxicity after chemotherapeutic drugs administration. We report a case of 66 year old female diagnosed with carcinoma ovary with moderate ascites posted for cytoreductive surgery and HIPEC.
Morquio syndrome, also described as Mucopolysaccharidoses (MPS) type IV A in literature, are rare progressive and autosomal recessive lysosomal storage diseases characterised by deficiency of enzymes N-acetyl-galactosamine-6-sulphate sulphatase and beta-galactosidase that decreases the catabolism of the glycosaminoglycans (GAGs) that cause accumulation of glycosaminoglycans in soft tissue, bone and cartilage giving rise to severe skeletal dysplasias including critical pectus carinatum, kyphoscoliosis, odontoid hypoplasia resulting in notable atlanto-axial instability, cervical stenosis, other joint deformities and dwarfism. It also poses major airway challenges as there is limited mouth opening, deformation of the oropharyngeal and laryngeal tissues, hypertrophied tonsils adenoids resulting in marked sleep apnea and macroglossia. Keratan sulphate (predominant GAG) accumulates in the hyaline cartilage of the trachea giving rise to tracheal stenosis and tracheomalacia. Pulmonary, cardiac and other vital organs dysfunction also adds to the risk of anesthesia related complications. In this article, authors will discuss the case of a 9 years old female child with Morquio syndrome and the successful management of airway and general anaesthesia challenges they faced.
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