Spastic type of cerebral palsy is the commonest disorder is associated with childhood disability. For spasticity corrections, orthopedic procedures are performed which are extremely painful. So, adequate pain relief is the priority during the immediate postoperative period for good perioperative outcomes. Ketamine being an N-Methyl D aspartate (NMDA) receptor antagonist blunts central pain sensation at a subanesthetic dose (0.3mg/kg or less IV) and is used as an adjuvant for perioperative analgesia. A subanesthetic dose has a minimal physiological impact as compared to an anesthetic dose. Ketamine, as a subanesthetic dose improves pain score and decreases opioid consumption during the perioperative period. We present, a case of a twelve-year-old female child known case of cerebral palsy came for spasticity correction of lower limbs under general anesthesia.
Takayasu's arteritis (TA) is a chronic inflammatory illness of the major arteries that is extremely rare. It mainly affects women of reproductive age which increases the risk of cardiovascular problems such hypertension and congestive heart failure. In this study, we discuss the case of a pregnant woman with TA who was diagnosed and managed successfully at a tertiary care facility with a good outcome. As a result, comprehensive care for TA patients has been shown to be critical in achieving optimal maternal and fetal/neonatal outcomes.
Introduction: Succinylcholine is a muscle relaxant of choice for paediatric intubation due to its fast onset and ultrashort duration of action but it is associated with unwanted sideeffects. Rocuronium bromide can be used alternatively to avoid those unwanted side-effects because of its fast onset and intermediate duration of action. Aim: To compare two doses of rocuronium bromide with succinylcholine in terms of intubating conditions, duration of action, haemodynamic variations, and complications to get a better alternative dose of rocuronium bromide in children undergoing elective surgeries. Materials and Methods: The present randomised, doubleblinded clinical trial study was conducted in the Department of Anaesthesiology, Jawaharlal Nehru Medical College (JNMC), Sawangi, Wardha, Maharashtra, India from January 2021 to October 2022. Ninety American Society of Anaesthesiology (ASA) Grade-I-II children of both sexes of 1-10 years age, undergoing elective surgery were equally divided into three groups. GroupR9 (n=30) and Group-R12 (n=30) received rocuronium bromide 0.9 mg/kg and 1.2 mg/kg, respectively while Group-S (n=30) received succinylcholine 1.5 mg/kg. Comparative evaluation of intubating conditions was done around 60 seconds in all three groups and duration of action, haemodynamic variations, and complications were noted. All data were entered in a microsoft excel sheet and results were expressed as percentages, mean Standard Deviation (SD), chi-square test, and Analysis of Variance (ANOVA) test where the difference was considered statistically significant if the p-value <0.05 by using the software Statistical Package for the Social Sciences version 11.0 (SPSS version 11.0). Results: Rocuronium bromide 1.2 mg/kg and succinylcholine 1.5 mg/kg provided excellent intubating conditions in 96.7% children and good intubating conditions in 3.3% children in both groups while rocuronium bromide 0.9 mg/kg provided excellent intubation conditions in 83.3% of children and good intubating conditions in 16.7% of children There was a significant difference present in intubation scores between three groups (p=0.01). The duration of action was longer with rocuronium bromide 1.2 mg/kg (38.93±4.323 min) as compared to rocuronium bromide 0.9 mg/kg (26.07±2.791 min) while it was shortest with succinylcholine 1.5 mg/kg (6.00±1.74 min). Adverse effects like fasciculations were only found in children (n=30) receiving succinylcholine (p=0.01) but not in rocuronium bromide groups. Conclusion: Rocuronium bromide 1.2 mg/kg gives the same intubating conditions as succinylcholine 1.5 mg/kg with good haemodynamic stability and no side-effects but the duration of action was longer with rocuronium bromide 1.2 mg/kg as compared to rocuronium bromide 0.9 mg/kg. So, to avoid unwanted sideeffects of succinylcholine in children, rocuronium bromide 1.2 mg/kg can be used as an alternative to succinylcholine 1.5 mg/ kg in children undergoing elective surgeries where early return of spontaneous recovery is not needed.
Peripartum Cardiomyopathy (PPCM), is an uncommon form of heart failure that occurs during the last month of pregnancy or upto five months after delivery. In this condition, the heart chamber enlarges and the muscle weakens. This case report is about a 30- year-old primigravida,with oligohydramnios, at 32.3 weeks of gestation. She visited for a caesarean section, and was diagnosed with PPCM on the basis of clinical findings of growing fatigability, troubled breathing and severe dyspnoea and on echocardiography ejection fraction of 64% with mild mitral regurgitation, moderate dilated left ventricle, tricuspid regurgitation was found. These patients require vigilantanaesthetic intervention for management of painless labour and/or either vaginal or operative delivery. The basic haemodynamic goals should always be kept in mind for favorable maternal as well as foetal outcomewhile selecting the drug dose and mode of anaesthesia. Various studies showed thatboth general and regional anaesthesia can be used with comparable outcomes in PPCM patients undergoing caesarean section. The index patient, who needed a cesarean section, was managed with Combined Spinal-Epidural (CSE) anaesthesia, weighing the risk of increase mortality due to general anaesthesia.
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