Ashish Kannaujia

A simple novel technique to make any supraglottic airway device magnetic resonance imaging compatible: A fusion of the past with the present

535 Anesthesia: Essays and Researches ¦ Volume 11 ¦ Issue 2 ¦ April-June 2017 Sir, A magnetic resonance imaging (MRI) study consists of multiple image sequences, each taking up to 10 min to acquire. Any movement during the procedure produces profound distortion of the final images obtained. This is especially problematic in the pediatric population and some adult patients with mental retardation or those suffering from claustrophobia. It often becomes necessary to provide either sedation or general anesthesia (GA) to these patients.

Spontaneous Extradural Hemorrhage in a Patient with Chronic Kidney Disease: A Case Report and Review of Literature

BACKGROUND Spontaneous extradural hemorrhage is a rare entity. It is usually reported in association with locoregional disease, which is often infective, inflammatory, and hematologic. Chronic kidney disease with hemodialysis is one of the most infrequent causes. The exact association or pathogenesis remains elusive, although possible mechanisms have been suggested. The presentation, associated comorbid conditions, and management vary among the reported cases. CASE DESCRIPTION A 39-year-old man with hypertension, well controlled with medications, and chronic kidney disease was on maintenance hemodialysis. He later underwent Tenckhoff catheter insertion for peritoneal dialysis; 2 weeks later, when peritoneal dialysis was started, he developed breathlessness. The Tenckhoff catheter was removed. However, the patient developed ascitic leak from the surgical site, which was repaired under general anesthesia. In the immediate postoperative period, he developed sudden, severe headache and was found to have bifrontal extradural hemorrhage. He underwent prompt drainage of the hematoma and was discharged on the fifth postoperative day in stable condition. CONCLUSIONS We report a rare case of spontaneous bilateral frontal extradural hemorrhage in the immediate postoperative period in a patient on hemodialysis. In addition, we review the existing literature on the topic.

Vasopressin infusion during combine spinal epidural anesthesia for cesarean section in a patient with severe mitral stenosis with pulmonary hypertension

Abstract Presence of mitral stenosis deteriorates the already compromised cardiac status of a pregnant female. Decision between regional and general anesthesia can be crucial in such cases. Our patient a 20-year-old, and primigravida scheduled for emergency cesarean section due to acute fetal distress was a diagnosed case of severe mitral stenosis and pulmonary hypertension (48 mmHg). During antenatal she was on anticoagulants and was monitored regularly. In the operation theater she was monitored for heart rate, invasive blood pressure, central venous pressure, SpO2 and urine output. We gave combined spinal epidural anesthesia (CSEA) at L3–4, using 7.5 mg 0.5% bupivacaine with 8% dextrose. Immediately after CSEA a continuous vasopressin infusion at 2–4 units/h was started, which took care of hypotension and pulmonary hypertension and it was stopped at the end of the surgery. The patient was stable hemodynamically intra and postoperatively. A baby of 2.2 kg was delivered with an APGAR score 7, 8, 9.

Prevention of hypotension induced by combined spinal epidural anesthesia using continuous infusion of vasopressin: A randomized trial

Background: Central neuraxial blockade (CNB) is an established technique of providing anesthesia for surgeries of the lower limb and abdomen. Hypotension is the most common side effect of CNB. It was hypothesized that by supplementing the initial burst of vasopressin following hypovolemia, hypotension following combined spinal epidural anesthesia (CSEA) could be avoided. Materials and Methods: A total of 122 patients undergoing lower limb and abdomen surgeries were included in the study, with 61 patients randomized into two groups - I and II. Patients in Group I received infusion of normal saline as soon as CSEA was applied. When systolic blood pressure (SBP) decreased to <90 mmHg, they received a 6 mg bolus of mephentermine to counteract hypotension. Patients in Group II received a continuous infusion of vasopressin as soon as CSEA was applied. If despite maximum dose of vasopressin, SBP dropped to < 90 mmHg, then intravenous mephentermine was administered to counteract hypotension. Hemodynamic parameters and side effects were noted. Results: Level of block attained in both groups was comparable in terms of dermatomal height. The mean SBP and mean arterial pressure values of Group I were significantly lower than in Group II in the initial 14 min. Diastolic BP was also significantly lower in Group I. Heart rate was found to be lower in Group II, especially after 30 min (P < 0.05). Conclusion: Maintaining plasma levels of the physiological burst of vasopressin helps to avoid hypotension following neuraxial blockade. Continuous infusion of vasopressin at 1–3 U/h can prevent hypotension following neuraxial blockade.

Perioperative management of patients with severe hypophosphataemia secondary to oncogenic osteomalacia: Our experience and review of literature

Oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome associated with mesenchymal tumours. It is characterised by phosphaturia, hypophosphataemia, decreased serum Vitamin D3 levels and severe osteomalacia. OOM-inducing tumours are usually benign, arising either from bone or soft tissue, with extremities and craniofacial region being the most common sites. Surgical resection of the tumour remains the mainstay of treatment. Challenges to an anaesthesiologist arise when such patients are planned for surgical resection of the underlying tumour. All the perioperative dilemmas are directly related to the severe hypophosphataemia. We describe three such cases of OOM and their perioperative management.

Distributing pulse oximeter: An initiative for improving patient safety and care

Advancements in various surgical techniques may be attributed to advances in the field of anaesthesia, and more so on account of better monitoring techniques.[1-3] In the last 50 years, there has been a significant reduction in anaesthesia-related morbidity and mortality. Patients undergoing surgery in low-income group countries still have 2to 3-fold increased mortality risk in comparison with high-income group countries.[4]

Post orbit exenteration cases: a "red flag" for airway management.

• Patients of orbital exenteration surgeries are at risk of developing orbito nasal fistulas.

A novel technique for securing supra-glottic airway device to prevent mal-positioning

Fixing of supra-glottic airway device with adhesive tape after proper placement may not be adequate. Many times, traction, weight of the tubes, heat and moisture exchange filter and unanticipated extubation force can displace a properly placed supra-glottic device. Different methods are used, i.e. Thomas’ tube holder, adhesive tape, MicroporeTM, LeucoplastTM, quill tape and suture to fix endotracheal tubes.[1-4] Similar techniques are also used for securing supra-glottic devices on tube holder, bed, shoulder, etc., but they are cumbersome and may displace during movement. Supra-glottic devices thus need to be secured properly to prevent malposition.

Laparoscopic port as an integral component of endoscopy mask: A novel innovation!

1. Kaseem HH, Elmody MF, Ewis EB, Mahdy SG. Incidence and predictors of post‐catheterization femoral pseudoaneurysm. Egypt Heart J 2013;65:213‐22. 2. Sirvent AE, Enríquez R, Martínez D, Reyes A. Delayed presentation of a femoral pseudoaneurysm after hemodialysis catheter insertion procedure. Nefrologia 2008;28:654‐5. 3. Behera C, Garudadhri GV, Kulbhushan P, Sunil N. Fatal pseudo aneurysm in common femoral artery: A case report. J Indian Acad Forensic Med 2011;33:80‐2. 4. Truong AT, Thakar DR. Radial artery pseudoaneurysm: A rare complication with serious risk to life and limb. Anesthesiology 2013;118:188. 5. Lenartova M, Tak T. Iatrogenic pseudoaneurysm of femoral artery: Case report and literature review. Clin Med Res 2003;1:243‐7. 6. Frankel A. Temporary access and central venous catheters. Eur J Vasc Endovasc Surg 2006;31:417‐22. 7. O’Sullivan GJ, Ray SA, Lewis JS, Lopez AJ, Powell BW, Moss AH, et al. A review of alternative approaches in the management of iatrogenic femoral pseudoaneurysms. Ann R Coll Surg Engl 1999;81:226‐34. Access this article online