Diaphragmatic hernia post esophagectomy is a rare complication but a reality in its existence. It is typically difficult to diagnose but highly depends on keeping high index of suspicion. In our case report, the young male who underwent esophagectomy for esophageal carcinoma, remained disease free and stable in his 9 months follow up, suddenly presented in the emergency department with the symptoms of shortness of breath, chest pain, vomiting and tachycardia. The case was typically complicated by the initial treatment given for acute ischemia and cardiogenic shock. Radiological findings proved to be helpful and turning point in the diagnosis and overall management.
Background: The practice of spinal and epidural anaesthesia is well established the world over for a number of years. Sighting of spinal or epidural is conducted through various approaches at various levels of the spinal column. The number of attempts has its correlation with the post-spinal and epidural complications.Aim: The aim is to gather information about the understanding among the anaesthetists about the spinal/epidural attempt.Materials and Methods: A pro forma comprising of nine closed-loop questions was distributed to all the participants in the study, and they were requested to fill it anonymously and placed it back in a designated sealed box in anaesthetic office.Results: A total of 20 pro formas were distributed, and all of them received back with 100% responses. All the participants accepted universally that attempting through another space makes it a second attempt. One of the respondents thought any backward movement means 2nd attempt, the majority of the responders thought it does not count as an attempt. Almost everyone considered another attempt if a needle is completely withdrawn and enters through another puncture site whether through a midline or paramedian approach.Conclusion: Most of the complications after neuraxial blockade are associated with the number of attempts alongside other factors that may play a role. A universal definition of a spinal and epidural attempt may decrease the complications associated with the central neuraxial blockade.Key words: Epidural, single attempt, spinal
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