The case history of a 35-year-old female patient with short stature is presented. She was posted for rectopexy in view of rectal prolapse. She was a known case of bronchial asthma. She had crowding of intervertebral spaces, which made administration of spinal anesthesia via the normal route very difficult. Taylor's approach for administration of the same was tried and proved successful, thus saving the patient from receiving general anesthesia in the presence of bronchial asthma, for a perineal surgery. The possible cause for the difficulty in administration of spinal anesthesia and the Taylor's approach are discussed, and reports of similar cases reviewed.
Cleft lip/palate are the most common craniofacial anomalies in children, with an incidence of 1:800 live births. Cleft palate alone occurs in 1:2000 live births 1 .It occurs due to the failure of fusion or break in fusion of nasal and maxillary processes with the palatine shelves, which form during 8 th week of the embryonic period. About 150 syndromes may be associated with cleft deformities. The most well-known are the Pierre Robin's, TreacherCollins and Goldenhaar syndrome. Congenital heart disease (CHD) occurs in 5-10% of these patients 1 .Surgical repair of cleft lip is usually done at 1-3 months of age for cosmetic purpose and cleft palate at 6 months to 1 year of age to promote facial growth and the speech. The successful outcome following cleft repair depends on the age of the patient, associated morbidities, anaesthetic expertise and post-operative care 1 . Infants with facial deformities are usually associated with abnormal dentition/hearing defect, recurrent ear/upper respiratory tract infection (URTI), pulmonary aspiration and poor nutrition. Until recently criteria for cleft repair in infants was 10 pounds of weight, 10 weeks of age and haemoglobin of 10gm% 2 . Recent concepts of early repair in neonates are based on improvements in parent-infant bonding, feeding, growth and speech development 2 . Anaesthesia for cleft surgery in infant and children carries a higher risk with general anaesthesia and airway complications due to associated respiratory problems. Review of literature mentions higher incidence of perioperative respiratory complications when associated with the common cold symptoms in children for cleft repairs 3,4 . Morbidity during general anaesthesia is associated with the difficult airway, endotracheal (ET) tube compression/disconnection and post-operative airway obstruction 1,4 . Down syndrome or Trisomy 21 is the most common chromosomal abnormality, and similar to KFS it also results in anatomical changes of the airways, such as: cleft lip and palate, narrow nasopharynx, and relatively large and protuberating tongue. The larynx and the cricoid ring tend to be small predisposing to acquired subglottic stenosis. Patients might have atlantoaxial subluxation, making neck extension risky 1 . Here we are presenting a 5 yr old male child with weight of 12kg for cleft palate repair with Down syndrome done under general anaesthesia.He was having complete cleft palate was seen with a bifid uvula. The cardiovascular,respiratory and per abdominal examinations had no positive findings.However,CNS examination showed hypotonia in all four limbs with power 2/5 in upper limbs and lower limbs.
Background:The pressor response, which is part of a huge spectrum of stress response, results from the increase in sympathetic and sympathoadrenal activity, as evidenced by increased plasma catecholamines concentrations in patients undergoing surgery under general anaesthesia. Various drug regimens and techniques have been used from time to time for attenuating the stress response to laryngoscopy and intubation, including opioids, barbiturates, benzodiazepines, beta blockers, calcium channel blockers, vasodilators, etc. The dose of opioids required for effective attenuation of stress response is fairly high and numerous drugs have been used as adjuncts in decreasing the dose of opioids with a varied level of success, but are not absolutely free from side-effects. This study was conducted to investigate the ability of pre-operative intravenous dexmedetomidine in decreasing the dose of opioids and anaesthetics for attenuation of haemodynamic responses during laryngoscopy and tracheal intubation in spine surgery.Methods: Fifty patients belonging to ASA I and II physical status were included in this study. Twenty five patients received 1μg/kg each of dexmedetomidine and Fentanyl pre-operatively (group D) and other twenty five patients received 2microg/kg of Fentanyl preoperatively (group F). Results:-Statistically significant changes in heart rate, blood pressure, sedation score, reduction in dose of induction agent, opioids demonstrated.Conclusion: Dexmedetomidine is not only an excellent drug for attenuation of pressor response to laryngoscopy and intubation and during extubation, but also decreases the dose of opioids and propofol in achieving an adequate analgesia and anaesthesia, respectively.
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