Spinal anesthesia has a quicker onset of action and completely blocks all motor functions. It req... more Spinal anesthesia has a quicker onset of action and completely blocks all motor functions. It requires less local anesthetic and has a reduced rate of failed blocks hence the preferred anesthetic method for lower abdomen procedures is spinal anesthesia. Intrathecal local anesthetics benefit from adjuvant medications by extending postoperative analgesia and thus improving the sensory blockade's duration and quality. Intrathecal opioids and local anesthetics work together synergistically to increase the sensory block while decreasing the sympathetic block. Adjuvants to local anesthetics for intrathecal administration have certain benefits, including lowered local anesthetic medication dose, improved hemodynamic stability, and fewer adverse effects. The opioid medication nalbuphine has a kappa agonist and mu antagonist action that reduces pain without having many negative side effects. It acts on opoid receptor as both an agonist and an antagonist to offer visceral nociception with...
Tetralogy Of Fallot (TOF), one of the most prevalent cyanotic congenital heart diseases in childr... more Tetralogy Of Fallot (TOF), one of the most prevalent cyanotic congenital heart diseases in children. Single step corrective surgery, early on in life, provides a fair expectation of favourable outcome in these individuals. However, complex, and skilled anaesthetic management is required by experienced team of healthcare providers. Preoperative surgical preparation, intraoperative key anaesthesia principles and postoperative care intensive care unit are all perioperative considerations in these patients. This article reports challenges faced in the perioperative anaesthesic management of a 3-year-old child having uncorrected TOF, who underwent Waterston shunt and later Intracardiac Repair (ICR). He presented with postoperative complication like cyanotic spell, gastrointenstinal bleeding, sepsis; but later recovered successfully.
Peripartum cardiomyopathy (PPCM) is an uncommon disorder of the cardiovascular system and is link... more Peripartum cardiomyopathy (PPCM) is an uncommon disorder of the cardiovascular system and is linked to high rates of morbidity and mortality. It is an idiopathic condition characterized by left ventricular systolic dysfunction with an ejection fraction of approximately 45% near the end of pregnancy or immediately after delivery. Anesthesia management in these women is challenging due to low physiological reserve and potential negative effects on the fetus. To ensure that mother and child are supported safely through delivery, careful anesthesia control is required. Here, in this review article, we discuss the anesthetic implications in preoperative, operative, and postoperative phases in women with perioperative cardiomyopathy undergoing vaginal delivery or cesarean section.
Rarely, an ovarian tumour will develop the growing teratoma syndrome. Growing teratoma syndrome o... more Rarely, an ovarian tumour will develop the growing teratoma syndrome. Growing teratoma syndrome of the cystic type has been linked to difficulties with anaesthesia because of the abdominal pressure the tumour exerts on the thorax. There haven't been any reports of this kind of ovarian tumour associated with ascites and bilateral pleural effusion in a paediatric age group. Here, we describe our anaesthetic experience in a case of developing solid-type ovarian teratoma syndrome with deranged lung status and haemodynamics. The patient was a 15-year-old female who was diagnosed with ovarian teratoma. She was scheduled for surgery when she arrived at our hospital with a 13 cm solid mass and respiratory distress. The patient's liver profile was abnormal; she had ascites, pleural effusion and a severely worsened lung condition. The patient was planned for an exploratory laparotomy and debulking surgery after preoperative optimisation. To prevent the re-expansion pulmonary oedema (RPO) following the excision of the tumour, a volumerestricted postoperative ventilation strategy was planned. Following enhanced recovery after surgery (ERAS) protocol and specific anaesthetic measures, we successfully managed the anaesthesia in a case of teratoma syndrome with a large abdominal tumour with successful recovery and early discharge from hospital.
Peripartum Cardiomyopathy (PPCM), is an uncommon form of heart failure that occurs during the las... more 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 anaesth...
The management of a problematic airway is one of the most critical tasks for an anaesthesiologist... more The management of a problematic airway is one of the most critical tasks for an anaesthesiologist. Airway issues are one of the most common causes of anaesthesia-related morbidity and mortality. Poor airway management has been recognised as a serious patient safety issue for nearly three decades, emphasising the significance of a comprehensive airway assessment before to anaesthesia induction.Mask ventilation and endotracheal intubation are considered challenging in patients with osteosarcoma of the jaw, where the mass protrudes from the mouth. Video laryngoscopic equipment, retrograde intubation, the laryngeal mask airway, Fibreoptic bronchoscope-guided intubation, and the pliable fibre optic stylet are among the procedures and equipment used to facilitate tracheal intubation in patients who are expected to have a difficult intubation. Anesthetists as well as surgeon prefer awake fibreoptic endotracheal intubation. Fiberoptic intubation with sedatives and local anaesthetics is a safe procedure for securing the airway in a difficult situation; even if the patient does not consent to an awake intubation. Here we report airway management of a 17 years old patient with osteosarcoma of jaw.
Due to the unique anatomical and physiological variations of the airway of a child with cleft lip... more Due to the unique anatomical and physiological variations of the airway of a child with cleft lip and palate, anesthesiologists may find it difficult to manage it properly. As a result, cleft lip and palate surgery in children will necessitate careful attention, detailed understanding, and practical application in anaesthetic preparation. While the majority of individuals have isolated CLP, a considerable percentage of them also have related abnormalities. Other issues with the formation of the branchial arch are the most noticeable (e.g. ear or upper airway defects). Anomalies of the heart, kidneys, and skeleton are among them. Associated anomalies could be part of a defined pattern, indicating which flaws to expect; the number of such disorders, including CLP, is growing by the day, ranging from the obvious, such as Trisomy 21, to the more subtle, such as Velocardiofacial Syndrome. Here we report anaesthetic management of a 13 old girl with congenital complete cleft of soft palate with kyphoscoliosis posted for surgical repair of soft palate under general anesthesia.
Spinal anesthesia has a quicker onset of action and completely blocks all motor functions. It req... more Spinal anesthesia has a quicker onset of action and completely blocks all motor functions. It requires less local anesthetic and has a reduced rate of failed blocks hence the preferred anesthetic method for lower abdomen procedures is spinal anesthesia. Intrathecal local anesthetics benefit from adjuvant medications by extending postoperative analgesia and thus improving the sensory blockade's duration and quality. Intrathecal opioids and local anesthetics work together synergistically to increase the sensory block while decreasing the sympathetic block. Adjuvants to local anesthetics for intrathecal administration have certain benefits, including lowered local anesthetic medication dose, improved hemodynamic stability, and fewer adverse effects. The opioid medication nalbuphine has a kappa agonist and mu antagonist action that reduces pain without having many negative side effects. It acts on opoid receptor as both an agonist and an antagonist to offer visceral nociception with...
Tetralogy Of Fallot (TOF), one of the most prevalent cyanotic congenital heart diseases in childr... more Tetralogy Of Fallot (TOF), one of the most prevalent cyanotic congenital heart diseases in children. Single step corrective surgery, early on in life, provides a fair expectation of favourable outcome in these individuals. However, complex, and skilled anaesthetic management is required by experienced team of healthcare providers. Preoperative surgical preparation, intraoperative key anaesthesia principles and postoperative care intensive care unit are all perioperative considerations in these patients. This article reports challenges faced in the perioperative anaesthesic management of a 3-year-old child having uncorrected TOF, who underwent Waterston shunt and later Intracardiac Repair (ICR). He presented with postoperative complication like cyanotic spell, gastrointenstinal bleeding, sepsis; but later recovered successfully.
Peripartum cardiomyopathy (PPCM) is an uncommon disorder of the cardiovascular system and is link... more Peripartum cardiomyopathy (PPCM) is an uncommon disorder of the cardiovascular system and is linked to high rates of morbidity and mortality. It is an idiopathic condition characterized by left ventricular systolic dysfunction with an ejection fraction of approximately 45% near the end of pregnancy or immediately after delivery. Anesthesia management in these women is challenging due to low physiological reserve and potential negative effects on the fetus. To ensure that mother and child are supported safely through delivery, careful anesthesia control is required. Here, in this review article, we discuss the anesthetic implications in preoperative, operative, and postoperative phases in women with perioperative cardiomyopathy undergoing vaginal delivery or cesarean section.
Rarely, an ovarian tumour will develop the growing teratoma syndrome. Growing teratoma syndrome o... more Rarely, an ovarian tumour will develop the growing teratoma syndrome. Growing teratoma syndrome of the cystic type has been linked to difficulties with anaesthesia because of the abdominal pressure the tumour exerts on the thorax. There haven't been any reports of this kind of ovarian tumour associated with ascites and bilateral pleural effusion in a paediatric age group. Here, we describe our anaesthetic experience in a case of developing solid-type ovarian teratoma syndrome with deranged lung status and haemodynamics. The patient was a 15-year-old female who was diagnosed with ovarian teratoma. She was scheduled for surgery when she arrived at our hospital with a 13 cm solid mass and respiratory distress. The patient's liver profile was abnormal; she had ascites, pleural effusion and a severely worsened lung condition. The patient was planned for an exploratory laparotomy and debulking surgery after preoperative optimisation. To prevent the re-expansion pulmonary oedema (RPO) following the excision of the tumour, a volumerestricted postoperative ventilation strategy was planned. Following enhanced recovery after surgery (ERAS) protocol and specific anaesthetic measures, we successfully managed the anaesthesia in a case of teratoma syndrome with a large abdominal tumour with successful recovery and early discharge from hospital.
Peripartum Cardiomyopathy (PPCM), is an uncommon form of heart failure that occurs during the las... more 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 anaesth...
The management of a problematic airway is one of the most critical tasks for an anaesthesiologist... more The management of a problematic airway is one of the most critical tasks for an anaesthesiologist. Airway issues are one of the most common causes of anaesthesia-related morbidity and mortality. Poor airway management has been recognised as a serious patient safety issue for nearly three decades, emphasising the significance of a comprehensive airway assessment before to anaesthesia induction.Mask ventilation and endotracheal intubation are considered challenging in patients with osteosarcoma of the jaw, where the mass protrudes from the mouth. Video laryngoscopic equipment, retrograde intubation, the laryngeal mask airway, Fibreoptic bronchoscope-guided intubation, and the pliable fibre optic stylet are among the procedures and equipment used to facilitate tracheal intubation in patients who are expected to have a difficult intubation. Anesthetists as well as surgeon prefer awake fibreoptic endotracheal intubation. Fiberoptic intubation with sedatives and local anaesthetics is a safe procedure for securing the airway in a difficult situation; even if the patient does not consent to an awake intubation. Here we report airway management of a 17 years old patient with osteosarcoma of jaw.
Due to the unique anatomical and physiological variations of the airway of a child with cleft lip... more Due to the unique anatomical and physiological variations of the airway of a child with cleft lip and palate, anesthesiologists may find it difficult to manage it properly. As a result, cleft lip and palate surgery in children will necessitate careful attention, detailed understanding, and practical application in anaesthetic preparation. While the majority of individuals have isolated CLP, a considerable percentage of them also have related abnormalities. Other issues with the formation of the branchial arch are the most noticeable (e.g. ear or upper airway defects). Anomalies of the heart, kidneys, and skeleton are among them. Associated anomalies could be part of a defined pattern, indicating which flaws to expect; the number of such disorders, including CLP, is growing by the day, ranging from the obvious, such as Trisomy 21, to the more subtle, such as Velocardiofacial Syndrome. Here we report anaesthetic management of a 13 old girl with congenital complete cleft of soft palate with kyphoscoliosis posted for surgical repair of soft palate under general anesthesia.
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