Background:
Since 1898 when August Bier, introduced spinal analgesia, there is lot of advancement made in the technique. There are various approaches and techniques for subarachnoid block.
Aim:
The aim of this study is to compare median and paramedian approach for spinal anesthesia for cesarean delivery using Sprotte needle in terms of number of attempts, success rate, adverse effects, and complications.
Materials and Methods:
One hundred patients were randomly divided into two equal groups and underwent subarachnoid block in median and paramedical block for elective cesarean section.
Results:
There is no significant difference between the two groups. Mean with standard deviation in the number of attempts for subarachnoid block through media and paramedian approach is 1.18 ± 0.48 and 1.06 ± 0.24, respectively (
P
= 0.51). The incidence of postdural puncture headache (PDPH) and lower backache was insignificant in both the groups (
P
= 0.218 and 0.646, respectively).
Conclusions:
Paramedian approach should not be considered as a reserve technique for spinal anesthesia and can be used as popularly as the median approach.
Percutaneous dilatational tracheostomy is a commonly performed bedside procedure in the Intensive Care Unit. Although serious and fatal complications have been reported, the procedure is by and large safe to perform in experienced hands. We report here an innocuous problem encountered twice. After the guidewire insertion and dilatation, subsequent railroading became difficult owing to migration of guidewire into the Murphy's eye of the endotracheal tube (ETT). Awareness about this possibility can avert inadvertent delays and complications during the procedure. A tug or gentle pulling of ETT after insertion of the guidewire rules out an impaction in the eye or other part of the ETT.
Background
Acute hypoxemic respiratory failure is the most common complication of COVID 19 infection. Newer ways for oxygen therapy were explored during this pandemic. High flow nasal oxygenation (HFNO) emerged as a novel technique for oxygenation and prevented the need for invasive mechanical ventilation during hypoxia among COVID patients. Using high flow oxygen dries the nasal mucosa and leads to skin disruption. We are presenting this case as this complication has not been reported anywhere to our knowledge.
Case presentation
Here we present a case of a 62-year-old male, who was on HFNO for a long time as a part of treatment for COVID 19 and developed ulceration in the nasal septa. Patient belonged to a geriatric age group and had diabetes mellitus. Close monitoring by ICU (intensive care unit) staff was a big problem during this pandemic. Daily physical assessment, good nutrition, and daily dressing with plastic surgery consultation helped treat our patient.
Conclusions
Geriatric patients with other co-morbidities are vulnerable to mucosal injury. Even in COVID era, everyday general physical surveillance is very vital in such patients to prevent these complications. During this pandemic close monitoring of patients suffered due to scarcity of ICU staff. In spite of that, it is a must to ensure daily physical surveillance and good supplemental nutrition especially in geriatric patients.
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