Pregnancy is associated with both anatomical and physiological changes in the body, especially in cardiovascular and respiratory systems. Patients with mediastinal non-Hodgkin lymphomas are recognized to be at risk for cardiorespiratory compromise perioperatively. Here we report the anesthetic management of a 28-year-old parturient primi with 38weeks gestation came to ER with leaking per vaginum posted for emergency caesarean section. She is a known case of non-Hodgkin's lymphoma diagnosed at 3 years of age and had a relapse at 12 years for which treated with chemotherapy. Challenges in conduct of anesthesia such as systemic effects of chemotherapeutic drugs, possibility of undiagnosed mediastinal mass and relapse of the disease and concerns pertaining to emergency cesarean section were assessed and anesthesia technique is tailored according to the above-mentioned concerns.
Pediatric patients with temporomandibular joint ankylosis have difcult airway due to limited mouth opening making intubation challenging. However beroptic bronchoscopy becomes the gold standard during these situations. We describe here an alternate way of securing airway during difcult cannot intubate situation through beroptic bronchoscope . A bougie was passed through mouth into the glottis under vision through the beroptic bronchoscope inserted through the nostrils. Through which an ETT of 4.5cm was rail roaded under vision. Thus airway was secured without any complications.
Hunter's syndrome, a very rare genetic disorder caused by a missing or malfunctioning enzyme iduronate-2-sulfatase, resulting in the accumulation of glycosaminoglycans in lysosomes. We report the airway management of an 8-year-old male child diagnosed as Hunters syndrome came with complaints of shortness of breath, lower respiratory tract infection and acute exacerbation of asthma. Admitted in pediatric ICU with severe wheeze and respiratory distress. Started on HFNC. Despite HFNC symptoms got worsened. So, planned for elective intubation. Child has large, protruded tongue, short neck. Difficult airway cart made ready. One attempt of video laryngoscopy and one attempt of normal laryngoscopy done. Unable to intubate so proceeded with tracheostomy as child was desaturating
Introduction: Preoperative anxiety may cause hemodynamic problems in the intraoperative period, increased analgesic need, and lower postoperative satisfaction of the patients. Melatonin has anxiolytic, sedative and potential analgesic effects when used as premedication before surgery. After institutional ethical committee clearance and patient Materials and methods: s informed written consent, 100 ASA 1 and 2 patients aged between 18 to 65 years posted for laparoscopic surgeries under GA were randomized into M and P groups with 50 in each. All patients received either 6mg oral melatonin dissolved in 3ml distilled water in melatonin group or 3ml distilled water in placebo group one hour before surgery. APAIS anxiety scale was measured before and one hour after premedication. Post operatively RSS scale for sedation and NRS scale for pain were measured at 30 min, 60 min, 90min, 120min in post anaesthetic care unit. The time of rst rescue analgesia was noted. APAIS anxiety Results: scores determined prior to administration of medications showed non-signicant differences between the groups (11.9 SD 1.3 in melatonin group, 11.8 SD 1.6 in placebo/control group). APAIS anxiety scores determined at one hour after receiving the study medication were decreased more signicantly in melatonin group than in control group with p value of 0.0005 (3.5 SD 1.1 in melatonin group, 7.5 SD 1.2 in placebo/control group). Postoperatively RSS scores showed better sedation in Melatonin group than in Placebo group. Pain scores were less in melatonin group than in placebo group. The time for rst request of rescue analgesia was delayed in melatonin group than in placebo. Preoperative oral Conclusion: melatonin 6mg reduces preoperative anxiety, postoperative pain and analgesia requirement.
INTRODUCTION Back pain is often reported as a common complaint after surgery following spinal anaesthesia. Many studies showed that the incidence of back pain after spinal anaesthesia is high and its magnitude is considerable in developing countries. It is highly related to reduced quality of life, loss of work productivity, burden of health care costs, and satisfaction regarding health care service; therefore, measures should be taken to reduce or prevent post spinal back ache. The aim of this prospective observational study is to asses the incidence of backache after spinal anaesthesia comparing gender, age and number of attempts. METHODS An institutional based prospective observational study was conducted from March to May 2022 in Saveetha Medical College Hospital, Thandalam, Chennai. A total of 100 participants were enrolled in this study. A convenience sampling technique was used to get the study participants. STATISTICAL ANALYSIS Both univariable and multivariable logistic regression were used to identify factors associated with postspinal back pain. Variables with a p value less than <0.2 in the bivariable analysis were tted into the multivariable analysis. In the multivariable analysis, a variable with a p value of <0.05 was considered statistically signicant. RESULTS The incidence of post spinal back pain was positively correlating with increase in number of attempts and increase in number of bony contacts during the spinal anaesthesia procedure and was higher in females and younger age group. DISCUSSION The overall incidence of back pain is high. Number of attempts and number of bone contacts are signicantly associated with the incidence of back pain following spinal anaesthesia. Post spinal back pain is of mild type and it manifests in rst two to six hours after surgical procedure when the local anaesthetic effect wears off. Fear of back pain in post spinal anesthesia is the main reason for patient refusal and it accounts for a rate of 13.4%. CONCLUSION This study conrms that overall incidence of backpain is high when the number of attempts, bone contacts are high .Hence, health professionals should minimize the number of attempts and bone contacts during lumbar puncture to reduce the incidence of post spinal back pain. Finally, conducting a similar study to assess the long term occurrence of postspinal back pain is recommended.
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