Uncontrolled pain in patients with rib fracture leads to atelectasis and impaired cough which can progress to pneumonia and respiratory failure necessitating mechanical ventilation. Of the various pain modalities, regional anaesthesia (epidural and paravertebral) is better than systemic and oral analgesics. The erector spinae plane block (ESPB) is a new modality in the armamentarium for the management of pain in multiple rib fractures, which is simple to perform and without major complications. We report a case series where ESPB helped in weaning the patients from mechanical ventilation. Further randomised controlled studies are warranted in comparing their efficacy in relation to other regional anaesthetic techniques.
Down's syndrome is the most commonly encountered congenital anomaly in medical practice. These patients are of special concern to medical practice because of their associated problems with regard to respiratory, cardiovascular and other systemic problems. As these patients present for repeated surgeries like dental extraction, facial reconstruction and fixation of cervical spine, these patients pose challenges to the anesthesiologist because of their unique set of problems, namely atlantoaxial instability, small trachea, congenital heart disease and repeated chest infections due to lowered immunity. Their reactivity to inhalational anesthetics and atropine is variable. Here we present an interesting case report of a child with Down's syndrome who presented with atlantoaxial instability for MRI of cervical spine under general anesthesia.KeyWords:atlanto axial instability, down’s syndrome, trisomy 21
The introduction of new chemotherapeutic agents for the treatment of multiple myeloma (MM) has improved the life expectancy and quality of life for these patients in the last decade. Therefore, more patients with MM are being treated for repeated pathological fractures. The anaesthesiologist should continue the optimum supportive care received by these patients in the perioperative period also, by understanding the pathophysiology of the disease, the adverse effects of the chemotherapeutic agents and the guidelines for their supportive care. We report the perioperative management of a patient with MM and discuss the perioperative anaesthetic considerations.
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