<p class="abstract">Hoarseness is a common entity encountered post intubation in cases operatively managed under general anaesthesia and during regional anaesthesia mainly in cervical/brachial plexus block as a consequence of involvement of phrenic nerve. Limited reports of hoarseness, associated with spinal anaesthesia (sub arachnoid block) in obstetric and gynecology cases have been documented by various authors. Here we document a case of hoarseness in 24-year-old parturient lasting for 10-14 days, after spinal anaesthesia with bupivacaine (H) for lower segment caesarean section. The hoarseness in this case can be due to unilateral vocal cord palsy as a consequence of high-level sympathetic blockade by administration of sub arachnoid block or vagal neuropathy due to intracranial hypotension, as a consequence of spinal fluid egress from dural puncture site<em>. </em>However, in our case no evidence of post dural puncture headache (PDPH) due to egress of cerebrospinal fluid from puncture site was noted, interestingly pointing towards lower pressure change threshold for occurrence of vagal nerve and vocal cord palsy viz PDPH.</p>
Background: Percutaneous tracheostomy or percutaneous dilation tracheostomy (PDT) is an airway management procedure routinely performed in critically ill patients, requiring prolonged ventilation. It is safely performed bedside by anaesthesiologist/intensivist in ICUs. Complications as endotracheal tube (ET) damage, loss of airway due to accidental extubation and piercing of guide wire through ET tube during procedure has led to exploration of safer/effective and viable airway alternatives while performing the procedures.Methods: In this study we randomised 60 patients to group E (ET) and group I (I gel) 30 each and studied ease of carrying out procedure and associated complication rates in both groups.Results: In ET group (group E), 9% of patients suffered with potentially catastrophic complications, e.g. loss of airway, inadequate ventilation of lungs, haemorrhage, airway leak due to ET tube cuff rupture and accidental extubation. In ETT group there was incidence of 18% cuff puncture by guide wire (p=0.025) and 3% accidental tracheal extubation. Group I witnessed lower incidence of haemorrhage (3%) and the incidence of guide wire piercing airway device was nil. Group I also demonstrated better hemodynamic stability attributed to lesser tissue trauma and airway manipulation.Conclusions: This study demonstrates enhanced safety with usage of I gel for PCDT, with less complication, better hemodynamic stability and shorter procedure duration.
Aim: To compare the efficacy and safety of Levosalbutamol versus racemic Salbutamol delivered by metered dose inhaler in children with moderate persistent asthma. Materials and Methods: Children enrolled in the study were randomized to receive MDI Levosalbutamol 2 puff thrice daily, 50 µgm/puff (group A) or MDI Racemic Salbutamol 2 puff thrice daily. 100 µgm/puff (group B).Baseline characteristics of both groups were comparable. The FEV 1 % and PEF % were assessed at baseline, at 15 minutes following the first dose on day 1 and on day 8. In children who remained symptomatic on day 8, an additional evaluation on day 15 was performed. Asthma symptom score were calculated from symptom score card. Results: There was significant improvement in PEF % and FEV 1 % within each group. But there was no statistically significant inter-group difference in PEF % change and FEV 1 % change except mean change in PEF % and ∆PEF % of initial on day 8 (at the end of 1 week). Asthma symptom score improved significantly in both groups but there was no inter group difference. Incidence of side effects like decrease in serum potassium level and increase in heart rate were comparable in between the two groups. Conclusion: Levosalbutamol administered via MDI improved PEF % significantly more in comparison of racemic Salbutamol after regular use of one week. However, no significant differences were observed in between the two drugs with respect to pulmonary function test on day 1, FEV 1 % on day 8 and asthma symptom score. The side effect profile of the two drugs was comparable. This suggests that Levosalbutamol is at least as efficacious as conventional Salbutamol in terms of clinical efficacy.
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