Anand H Kulkarni

Ludwig's angina and airway considerations: a case report

IntroductionPatients with deep neck infections present challenging airways for an anesthesiologist. Patients with Ludwigs angina may die as a result of the inability to effectively manage the airway.Case presentationHere we discuss the anesthetic management with fiberoptic intubation of a 45-year-old man with Ludwigs angina scheduled for emergency drainage.ConclusionAwake fiberoptic intubation under topical anesthesia may be the ideal method to secure the airway in advanced cases of Ludwigs angina. When fiberoptic bronchoscopy is not feasible, not available or has failed, an awake tracheostomy may be the preferred option.

Comparative evaluation of midazolam and butorphanol as oral premedication in pediatric patients

Background: To compare oral midazolam (0.5 mg/kg) with oral butorphanol (0.2 mg/kg) as a premedication in 60 pediatric patients with regards to sedation, anxiolysis, rescue analgesic requirement, and recovery profile. Materials and Methods: In a double blinded study design, 60 pediatric patients belonging to ASA class I and II between the age group of 2–12 years scheduled for elective surgery were randomized to receive either oral midazolam (group I) or oral butorphanol (group II) 30 min before induction of anesthesia. The children were evaluated for levels of sedation and anxiety at the time of separation from the parents, venepuncture, and at the time of facemask application for induction of anesthesia. Rescue analgesic requirement, postoperative recovery, and complications were also recorded. Results: Butorphanol had better sedation potential than oral midazolam with comparable anxiolysis at the time of separation of children from their parents. Midazolam proved to be a better anxiolytic during venepuncture and facemask application. Butorphanol reduced need for supplemental analgesics perioperatively without an increase in side effects such as nausea, vomiting, or unpleasant postoperative recovery. Conclusion: Oral butorphanol is a better premedication than midazolam in children in view of its excellent sedative and analgesic properties. It does not increase side effects significantly.