BACKGROUND AND OBJECTIVES:Ebstein's anomaly is one of the rare congenital heart conditions that occur due an abnormal development of the tricuspid valve with "atrialization" of the right ventricle, leading to a small effective distal portion causing poor ventricular function. It may be associated with other cardiac malformations, rhythm disturbances or even a failing heart. When these patients report for surgery, the anaesthetic considerations are serious and reports about the use of central neuraxial blockade for the same is rare. Hence this study aims to provide some knowledge and information on the use of subarachnoid block in a case of Ebstein's anomaly posted for haemorrhoidectomy. PRESENTATION: DIAGNOSIS AND MANAGEMENT: A 48year old female patient with external and internal haemorrhoids was posted for haemorrhoidectomy. She was a known hypertensive with grade 1 hypertensive retinopathy on fundoscopy and was on treatment for the same. ECG showed a WPW syndrome pattern and chest radiograph showed mild cardiomegaly. 2D echocardiography revealed a dilated right atrium and right ventricle, with apical displacement of septal tricuspid leaflet and Ebstein's anomaly. There was moderate tricuspid regurgitation. Biventricular function was good with intact septum. The ejection fraction was 65%. The patient was given a low subarachnoid block in anti-trendelenberg position in the L3-L4 interspace with a combination of bupivacaine 0.5% heavy 4.5mg and fentanyl 15mcg (Total volume of 1.2ml). There was good anaesthetization with sensory and motor blockade of the saddle area. The patient was haemodynamically stable, without hypotension, rhythm disturbances or any other untoward incident throughout the procedure and in the postoperative period. CONCLUSION: Very few reports are available on the use of subarachnoid block in patients with Ebstein's anomaly. The feared drawback with its use is the occurrence of precipitous hypotension, leading to worsening of right to left shunt when it is present. Though our patient had an associated Wolff Parkinson White syndrome, she had no additional serious conditions like septal defects with reversal of flow or cardiac failure. Hence, we considered giving a low dose saddle block in view of the site of surgery and to minimize the sympathetic blockade.
The established methods of interscalene block were based on either proper motor response on paresthesia or nerve stimulation technique. In this study, we compared with nerve stimulator for interscalene blocks using 20ml of 0.75% ropivacaine and 20ml of 0.75% ropivacaine with 50 mcg of fentanyl. The aim of our study is to compare duration of sensory and motor blockade by adding fentanyl. METHODS: A total of 60 patients receiving interscalene block were randomly allocated to Group A who received 20ml 0.75% ropivacaine and Group B who received 20ml 0.75% Ropivacaine with 50 mcg of fentanyl. The onset of sensory and motor blocks, duration of sensory and motor block and time of rescue analgesia were observed. RESULTS: The onset of sensory block in group A (2.5±0.5) and in group B (2.38±0.43) (p=0.3231) and onset of motor block in group A (5.8±3.53) and in group B (5.1±2.8) (p=0.3983) which is not significant. The duration of sensory block in group A (6.4±0.35) and in group B (9.5±1.0) (p<0.0001). The duration of motor block in group A (5.17±0.8) and in group B (8.4±1.53) (p<0.0001) and the duration of rescue analgesia required in group A (7.10±0.25) and in group B (8.4±1.53) (p<0.0001). All the three parameters compared were extremely statistically significant. CONCLUSION: We conclude that the interscalene block using nerve stimulator technique with 20ml of 0.75% Ropivacaine with fentanyl 50 mcg significantly prolongs duration of sensory, motor blockade and time of requirement of rescue analgesia.
The incidence of breast carcinoma is on the rise in Asian countries like India and pulmonary tuberculosis is one of the most common infectious diseases encountered here. Although coexistence of active pulmonary tuberculosis and breast cancer in same patient is rare, it poses a huge challenge to the anaesthetist when patients having the above conditions concomitantly are posted for surgeries like mastectomy. Here we report the anaesthetic management of a case of breast carcinoma with active pulmonary tuberculosis managed successfully under thoracic epidural anaesthesia chosen to avoid major hemodynamic, respiratory and other complications like operation theatre pollution and drug interactions between anti tubercular and anticancer drugs and drugs used for general anesthesia.
Mediastinal masses can compress major airways, so patients with this condition should be evaluated carefully before subjecting them to anaesthesia. There have been many reports of hemodynamic and airway collapse induced by general anaesthesia in patients with an anterior mediastinal mass. Bronchial carcinoids which account for 0.5% to 2.5% of all the lung malignancies may have the unusual presentation of an anterior mediastinal mass. Carcinoid tumours pose a great challenge to the anaesthesiologists especially if carcinoid syndrome is present. We report the case of a 30-year-old gentleman who presented to us with persistent cough, diagnosed to have a large anterior mediastinal mass and was posted for debulking of the same. It was suspected to be a bronchial carcinoid intraoperatively and pneumonectomy was done and the histopathological diagnosis confirmed in the postoperative period.
BACKGROUND Acute hyperglycaemia in peri-operative period is associated with significantly increased organ specific complications. Acute hyperglycaemia during surgery worsens prognosis even in the patients who had normal glucose tolerance test. In few studies the effects of propofol and thiopentone were compared. In this study, we evaluated the effect of Propofol and Thiopentone on blood glucose during elective surgeries done under general anaesthesia in non-diabetic patients. MATERIALS AND METHODS After approval by the institutional ethical committee and oral informed consent, 60 patients aged between 20 years and 60 years, ASA 1 and 2 who underwent elective surgeries under general anaesthesia were studied in this double blind, prospective, randomized comparative study. This study was conducted to compare the effects of anaesthetic induction with single dose propofol versus thiopentone on blood glucose and haemodynamics. RESULTS The mean difference in blood sugar between propofol and thiopentone groups is not statistically significant. (t=1.003, df=54, p=0.320).There was no significant increase in heart rate, systolic blood pressure, diastolic blood pressure & mean arterial pressure at T5 & T15 in both the groups. CONCLUSION From the observations and results of the study, we conclude that I.V. propofol and I.V. thiopentone prevent hyperglycaemia when values were compared with basal readings. Haemodynamic parameters were not statistically significant in both the groups.
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