Carotid body tumor (CBT) is a rare tumor, which arises at bifurcation of carotid artery from chemoreceptor cells. These cells sense the partial pressure of oxygen and carbon dioxide from the blood. Hence, carotid body plays an important role in the control of ventilation during hypoxia, hypercapnia, and acidosis. The tumor arising from these cells is benign and has tendency to turn out malignant. This tumor is found in persons who live at high altitudes. Removal of tumor poses several anesthetic challenges and perioperative morbidity or mortality. We report successful anesthetic management of CBT excision.
Introduction:Anesthesiologists are exposed to extreme level of stress from beginning of career. With evolution of super-specialty branches, level of stress faced has also raised. Prolonged working hours, poor hospital facilities and dependencies on surgeon are main contributing factors. Stress and unsatisfactory remuneration may lead to decrease in job satisfaction. One should have a good quality of life, but high level of stress may itself compromise quality of life. This study aims at assessment of stress, quality of life spent, job satisfaction, and health issues.Aim:The aim is to study stress level, job satisfaction, and quality of life of practicing Indian anesthesiologists.Setting and Design:This was an online survey, descriptive study.Subjects and Methods:An online survey consisting of 21 questions was sent to Indian anesthesiologists by E-mail using SurveyMonkey platform. The responses were collected and analyzed.Results:Out of 1219 anesthesiologists, 81% were satisfied being anesthesiologist, but 58% are unsatisfied with remuneration. More than one role was played by 47.7% of anesthesiologists. Nearly 83% of anesthesiologists agreed that the stress is highest among anesthesiologist compared to other medical professionals. Stress does reduce with the presence of another anesthesiologist while managing cases. Most anesthesiologists practiced various stress reduction methods of which spending time with the family was most popular method.Conclusion:This study divulges working pattern, job satisfaction, level of stress faced, methods to alleviate stress, and quality of life of anesthesiologists in India. A balanced family and professional life with proper utilization of leisure will reduce the stress.
It is not uncommon to see in developing and underdeveloped countries, where the anesthesiologist who is untrained in cardiac specialty takes care of cardiac catheterization centers. The service in cardiac catheterization laboratories (CCL) in developed countries and some of the developing countries is mainly provided by the cardiac anesthesiologists. The scenario is not same in some part of developing countries or in underdeveloped countries which are mainly due to increase in number of CCL (catheterization laboratory) when compared to the number of cardiac anesthesiologists working outside the operation theater. It is also important for training the postgraduate in this field as to make them capable and competitive in managing such cases during emergency situation as it may save the life of a patient. Many a times, CCL is built as per the need of cardiologist ignoring the basic needs of cardiac anesthesiologist. It is important to note that anesthesiologist should be competent enough to provide complete, integrated anesthetic care outside the operation theater with available resources. It is challenging for the anesthesiologist to provide sedation or general anesthesia in such critical area where he/she will be dealing with life-threatening situations. In the modern era, the interventional techniques are advancing and treating complex heart diseases is more often. Days are not far where the CCL procedures may reduce the requirement of major surgeries. A careful and dedicated approach by the anesthesiologist with thorough knowledge and skills decreases morbidity and mortality rate. This article helps both cardiac and noncardiac anesthesiologists to improve their knowledge and to approach the patient systematically.
Bicuspid aortic valve is the most common birth defect affecting the heart and is present in 1-2% of the population. The abnormal valve structure leads to turbulent flow, fibrosis, calcification, and aortic stenosis. Aortic stenosis increases perioperative morbidity and mortality. Anesthetic techniques that reduce systemic vascular resistance (regional neuraxial techniques) must be used with extreme caution. Hashimoto's disease or chronic thyroiditis or autoimmune thyroiditis is the most common cause of hypothyroidism in adults. Regional anesthesia is preferred in patients with hypothyroidism as recovery from general anesthesia may be delayed by hypothermia, respiratory depression, or slow drug biotransformation. This is a case report of anesthetic management of a middle-aged female with co-existing aortic stenosis, hypothyroidism, and fibroid uterus posted for abdominal hysterectomy.
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