as a part of stem cell therapy with age > 5 years were included. Patients unwilling for consent and patients requiring general anesthesia were excluded. Drugs and dosages used were noted. Hemodynamic parameters were noted every 5 minutes. Sedation levels were monitored using Ramsay sedation score every 10 minutes. Statistical analysis was done using the unpaired "t" test and p value of < 0.05 was considered significant.Results: The age range was from 6 to 32 years with average of 11.59 years. Most commonly used drugs for procedural sedation were midazolam, dexmedetomidine infusion, and ketamine. Hemodynamic stability was maintained in all patients. Respiratory rate and end-tidal CO 2 were maintained close to baseline (p > 0.05). No cardiorespiratory adverse events were noted.Conclusion: Dexmedetomidine and ketamine provide good procedural sedation without causing cardiorespiratory depression, maintain airway reflexes, and offer adequate analgesia along with local anesthesia. The study subject draws attention to an often-neglected area and has scope for change in future practice.Introduction: Anesthesia in Duchenne muscular dystrophy (DMD) poses many challenges, because of poor cardiorespiratory function, weak airway muscles, macroglossia, or obstructive sleep apnea. The present study was undertaken to evaluate safety as well as efficacy of procedural sedation techniques, and to assess the effect on hemodynamic and respiratory parameters in patients of DMD.Methodology/Description: The present prospective, observational study was performed in 54 consecutive male patients of DMD presenting for stem cell therapy. After institutional ethics committee approval, patients coming for elective bone marrow aspiration and intrathecal catheterization S15 Abstracts Journal of Neuroanaesthesiology and Critical Care Vol. 5 No.1/2018 limbs (p < 0.05). Overall success rate of MEP recordings was higher in upper limbs. The current and stimulating pulse needed to elicit responses was also higher in lower limbs. Limitations: single institutional study, smaller sample size.Conclusion: Thus, propofol-based anesthesia appears to suppress MEP recordings in lower limbs as compared with upper limbs.
Introduction:Intraoperative-neurophysiological monitoring (IONM) is important to delineate the epileptogenic lesions from the eloquent cortex. Many anesthetic agents have significant interference in monitoring of electrocorticography (ECoG), somatosensory evoked potentials (SSEPs), and motor evoked potentials (MEPs). Complete relaxation with moderate depth is needed for ECoG, while muscle relaxation will not elicit MEP. Hence, a narrow balance is required to conduct recording of ECoG, SSEP, and MEP simultaneously. Here, we present successful management of two such cases under general anesthesia where judicious use of anesthetic agents provided least interference to IONM. Methodology/Description: A 7-year-old child presented with premotor cortical dysplasia posted for right frontotemporal craniotomy. Aim was to develop anesthetic technique to eli...
The use of dexmedetomidine is in increasing trend particularly in patients with neurological disorders. A very few studies have focused on the cerebral haemodynamic effects of dexmedetomidine. This study is aimed to address this issue. Methods: Thirty patients without any intracranial pathology were included in this study. Middle cerebral artery flow velocity (FV) obtained from transcranial colour Doppler was used to assess the cerebral haemodynamic indices. Mean FV (mFV), pulsatility index (PI), cerebral vascular resistant index (CVRi), estimated cerebral perfusion pressure (eCPP) and zero flow pressure (ZFP) were calculated bilaterally at baseline and after infusion of injection dexmedetomidine 1 mcg/kg over 10 min. Results: Twenty-six patients completed the study protocol. After administration of loading dose (LD) of dexmedetomidine, mFV and eCPP values were significantly decreased in both hemisphere (P < 0.05); PI, CVRi and ZFP values showed significant increase (P < 0.05) after dexmedetomidine infusion. Conclusion: Increase in PI, CVRi and ZFP suggests that there is possibility of increase in distal CVR with LD of dexmedetomidine. Decrease in mFV and eCPP along with increase in CVR may lead to decrease in cerebral perfusion. This effect can be exaggerated in patients with pre-existing neurological illness. Further studies are needed to evaluate the effect of dexmedetomidine on various other pathological conditions involving brain such as traumatic brain injury and vascular malformations.
ISNACC-S-27Cerebral oxygenation during electroconvulsive therapy Kaushik Theerth, Tanmay Jadhav, Sriganesh Kamath, Madhusudan Reddy Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India Background: Near-infrared spectroscopy is a novel monitor to detect cerebral oxygenation (rSO 2 ). A very few studies have analysed the effect of electroconvulsive therapy (ECT) on rSO 2 . We hypothesised that atropine pre-medication related activation of systemic and cerebral haemodynamics will exacerbate ECT-induced increase in rSO 2 . This study aimed to assess the effect of atropine and no atropine pre-medication during ECT on rSO 2 and correlate this with haemodynamics and peripheral oxygen saturation. Methodology: Psychiatric patients aged between 18 and 60 years requiring modified ECT for their illness were included in this 6-month study. This was a randomised crossover trial, in which patients served as their own controls. For the second ECT session, patients were randomised to receive either 0.01 mg/kg atropine or no atropine preceding anaesthesia.
Systemic complications following liquid glue embolisation of intracranial pial arteriovenous fistulae (AVF) are uncommonly reported. We report a patient who had a pulmonary embolism of a liquid glue during endovascular treatment of a pial AVF. The patient had haemodynamic instability, pulmonary hypertension, increased alveolar dead space and increased brain natriuretic peptide levels. In addition to other supportive measures, her pulmonary hypertension was controlled with sildenafil. Ten months after the event, the patient had a considerable improvement of the clinical and laboratory variables and a significant radiographic resolution of the glue from the pulmonary circulation.
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