Conjoined twins are a rare congenital anomaly of unknown aetiology. We report the successful anaesthetic management of separation of ischiopagus tetrapus conjoined twins. The importance of a multidisciplinary approach, thorough pre-operative evaluation and planning, vigilant monitoring and anticipation of complications such as massive blood and fluid loss, haemodynamic instability, hypothermia and intensive, post-operative care are emphasised.
Background:Dexmedetomidine, an α2 adrenergic agonist, has been found to be a useful adjuvant to local anesthetics. It has been found to produce satisfactory block with lower doses of spinal bupivacaine.Aim:The aim of this study is to compare the difference in spinal block characteristics and hemodynamic effects of 7, 8, and 9 mg hyperbaric bupivacaine combined with 5 μg dexmedetomidine and to find out the optimum dose that would provide satisfactory block and hemodynamic stability for lower limb orthopedic surgeries.Settings and Study Design:This was a prospective, observational study.Materials and Methods:Ninety patients undergoing lower limb orthopedic surgeries were allocated to three groups of thirty each. Group A received 7 mg, Group B 8 mg and Group C 9 mg 0.5% hyperbaric bupivacaine along with dexmedetomidine 5 μg. The spinal block characteristics, hemodynamic stability, and side effects were compared.Statistical Analysis:The quantitative variables were compared using ANOVA test and the qualitative variables using Chi-square test.Results:All three groups had satisfactory anesthesia and analgesia. The onset of analgesia was slower and peak sensory level lower in Group A. The onset of motor block, time to attain peak sensory levels, duration of analgesia, maximum pain scores, and requirement of rescue analgesics were comparable among groups. Duration of motor block and time of regression of sensory level were more in Group C. Hemodynamics and sedation scores were comparable.Conclusion:Dexmedetomidine with lower doses of bupivacaine produces satisfactory anesthesia without hemodynamic instability. A dose of 7 mg bupivacaine with 5 μg dexmedetomidine may be sufficient for orthopedic surgeries.
BACKGROUNDShivering is an unpleasant complication of regional anaesthesia. Both tramadol and pethidine have been found to be effective in suppressing shivering. The aim of our study was to compare the efficacy of equipotent doses of tramadol and pethidine for control of shivering in patients undergoing spinal anaesthesia. MATERIALS AND METHODSA randomized double blind study was conducted on 60 patients undergoing Caesarean section who developed shivering during spinal anaesthesia. Approval was obtained from the Institutional Ethics Committee. The patients were randomly allocated to two groups of 30 each. Group T (n=30) received tramadol 0.5 mg/kg and Group P (n=30) received pethidine 0.5 mg/kg at the onset of shivering. The parturient was asked to assess the effect of treatment. The anaesthesiologist independently noted the time taken for shivering to subside. The degree of sedation and incidence of nausea and vomiting were also noted. The quantitative variables were compared using the unpaired t test and the qualitative variables using the Chi-Square test. RESULTSA total of 64% of patients in Group T and 86% in Group P noted improvement (P=0.003) at 5-minutes after drug administration. 43.3% in Group T had their shivering controlled compared to 83.3% in Group P (P=0.001) as assessed by the Anaesthesiologist. Sedation was more with pethidine than tramadol. The incidence of nausea was comparable, and no vomiting occurred in either group. CONCLUSIONPethidine 0.5 mg/kg is superior to tramadol 0.5 mg/kg when used for the control of intraoperative shivering under spinal anaesthesia though it can produce more sedation.
Summary Supraglottic airway devices are commonly used to manage the airway during general anaesthesia. There are sporadic case reports of temporomandibular joint dysfunction and dislocation following supraglottic airway device use. We conducted a prospective observational study of adult patients undergoing elective surgery where a supraglottic airway device was used as the primary airway device. Pre‐operatively, all participants were asked to complete a questionnaire involving 12 points adapted from the Temporomandibular Joint Scale and the Liverpool Oral Rehabilitation Questionnaire. Objective measurements included inter‐incisor distance as well as forward and lateral jaw movements. The primary outcome was the inter‐incisor distance, an accepted measure of temporomandibular joint mobility. Both the questionnaire and measurements were repeated in the postoperative period and we analysed data from 130 participants. Mean (SD) inter‐incisor distance in the pre‐ and postoperative period was 46.5 (7.2) mm and 46.3 (7.5) mm, respectively (p = 0.521) with a difference (95%CI) of 0.2 (−0.5 to 0.9) mm. Mean (SD) forward jaw movement in the pre‐ and postoperative period was 3.6 (2.4) mm and 3.9 (2.4) mm, respectively (p = 0.018). Mean (SD) lateral jaw movement to the right in the pre‐ and postoperative period was 8.9 (4.1) mm and 9.1 (4.0) mm, respectively (p = 0.314). Mean (SD) lateral jaw movement to the left in the pre‐ and postoperative period was 8.8 (4.0) mm and 9.3 (3.6) mm, respectively (p = 0.008). The number of patients who reported jaw clicks or pops before opening their mouth as wide as possible was 28 (21.5%) vs. 12 (9.2%) in the pre‐ and postoperative period, respectively (p < 0.001) with a difference (95%CI) of 12.3% (6.7–17.9%). There was no significant difference in the responses to the other 11 questions or in the number of patients who reported pain in the temporomandibular joint area postoperatively. No clinically significant dysfunction of the temporomandibular joint following the use of supraglottic airway devices in the postoperative period was identified by either patient questionnaires or objective measurements.
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