ABSTRACT:We report a case who presented with respiratory distress after trauma that was treated for a left-sided haemopneumothorax. This was finally diagnosed as giant diaphragmatic hernia with tension gastrothorax. The diagnostic difficulties and complications of wrong diagnosis are discussed.
BackgroundEarly prediction of hypotension helps to decide appropriate prophylactic measures and, hence, safe anaesthesia for mothers and improved neonatal outcomes. Perfusion index (PI) measured from a standard pulse oximeter has shown positive results in the prediction of hypotension. This study aims to determine if PI can equally predict hypotension in parturients after administration of spinal anaesthesia at different time points. MethodsParturients posted for elective caesarean section belonging to the American Society of Anesthesiology II (ASA II) were divided into two groups based on baseline PI as group A <3.5 and group B ≥3.5. Fifty-six parturients were enrolled in the study. PI and blood pressure were monitored at baseline, every two minutes for 12 minutes and every five minutes until the end of the surgery, after administration of spinal anaesthesia with hyperbaric bupivacaine 10 mg. Incidence of hypotension was compared between groups at all time points of observation. Spearman's rank correlation coefficient was determined to check the correlation between baseline PI and the number of episodes of hypotension. Receiver operating characteristic (ROC) curve was plotted to determine the ideal cut-off at different time points. ResultsBaseline PI significantly correlated with the number of episodes of hypotension (r-0.525). The overall incidence of hypotension was significantly higher in parturients with baseline PI ≥3.5 (79.16%) as compared to those with PI <3.5 (33.33%). The incidence of hypotension at sixth, 10th and 37th minutes post-spinal anaesthesia administration was significantly higher in the group with PI ≥3.5. The sensitivity and specificity for the 3.5 cut-off of PI were 85.7% and 60%, respectively, at the 6th and 10th minute after spinal administration. A higher cut-off of 3.9 increases the specificity to 69% without much change in the sensitivity. ConclusionParturients with PI >3.9 at baseline have a higher risk of hypotension in the initial 10-12 minutes following spinal anaesthesia during caesarean delivery.
BACKGROUND:The standard techniques of tracheal intubation are usually done after induction of anaesthesia followed by skeletal muscle relaxation. The muscle relaxants are associated with many side effects. These side effects have spurred research into development of alternative methods for providing good intubating conditions. AIMS AND OBJECTIVES: Present study is designed to compare the intubating conditions, hemodynamic changes following two different doses of fentanyl (2 and 3mcg/kg) using midazolam, lignocaine and propofol induction. MATERIALS AND METHOD: A prospective randomized study was carried out in the department of Anaesthesia at Rajarajeswari Medical College and Hospital. The patients of either sex and age group between 18 and 60years belonging to ASA I and II scheduled for operation under general anaesthesia in various surgical departments for elective surgery were subjects of our study. Patients were randomly divided into two groups of 50 patients each. Group-I received Midazolam (0.04mg/kg), study drug Fentanyl (2mcg/kg), Lignocaine (1.5mg/kg) and propofol (2mg/kg). Group-II received Midazolam (0.04mg/kg), study drug Fentanyl (3mcg/kg), Lignocaine (1.5mg/kg) and propofol (2mg/kg). STATISTICAL ANALYSIS: To assess the intubating conditions Statistical test used was chi square test and software used was SPSS version 10. The power we achieved for response to intubation is 0.95. To assess the hemodynamic effects Statistical test used was paired t test within the group and student t test between the groups and software used was SPSS version 10. The power we achieved for pulse rate and mean BP is 0.81 and 0.93 respectively. RESULTS AND CONCLUSION: showed that fentanyl 3mcg/kg with propofol, midazolam and lignocaine provides better intubating conditions and effective in blunting hemodynamic responses to intubation when compared to fentanyl 2mcg/kg. Fentanyl 3mcg/kg with propofol, midazolam and lignocaine combination represents a useful alternative technique for tracheal intubation when neuromuscular blocking drugs are contraindicated or should be avoided.
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