Kanil Ranjith Kumar

Unanticipated subglottic stenosis complicating airway management of a child with Langer–Giedion syndrome

1 Murphy E, Willis S. Awareness and hypoxia risk with Dragger Cato and Fabius anaesthesia machine. Anaesth Intensive Care 2004; 32: 721–722. 2 Robinson BJ, Caldwell C, Mark M. Design of new anaesthesia machines. Anaesth Intensive Care 2005; 33: 413. 3 Medical devices – application of usability engineering to medical devices IEC 62366:2007. Available at: http://www.iso.org/iso/home/ store/catalogue_tc/catalogue_detail. htm?csnumber=38594. Accessed 29 July, 2013. 4 Dalley P, Robinson B, Weller J et al. The use of high fidelity human patient simulation and the introduction of new anaesthesia delivery systems. Anesth Analg 2004; 58: 1737–1741.

Intravenous dexmedetomidine augments the oculocardiac reflex

To the Editor: We read with interest the recently published study by Arnold and colleagues, “Intravenous dexmedetomidine augments the oculocardiac reflex.” I have a comment regarding the method of dexmedetomidine administration for evaluation of percentage oculocardiac reflex (OCR). Dexmedetomidine is a highly selective a2adrenoceptor agonist, and its effects on reduction in heart rate (HR) and blood pressure have been well documented in both adults and children. Intravenous dexmedetomidine bolus should be administered over 10 minutes, followed by continuous infusion for maintenance to prevent hemodynamic changes. Decrease in HR up to 30% from baseline until 30 beats/min after 0.5 mcg/kg initial dose over 10 min has been reported. Rapid bolus of 0.5mcg/kg dexmedetomidine in 5 seconds has been used for convenience during treatment of emergence delirium, showing significant decrease in HR below the lower limit for age as compared to the control group and decrease in HR may last till 4 minutes of injection. Arnold and colleagues recorded HR after administration of rapid bolus dexmedetomidine, which will lead to decrease the HR because of the selective a2-adrenoceptor agonist effect of dexmedetomidine. This decrease in HR can occur without traction of muscle and should not be extrapolated as OCR, which may lead to bias in the results.

Acute exacerbation of Chiari malformation: A rare cause for non-awakening from anaesthesia

Anaesthesia was induced with fentanyl 25 mcg and propofol 30 mg. Atracurium 6 mg was used for orotracheal intubation. Intubation was uneventful, and the child was placed prone with head in neutral position. Anaesthesia was maintained with oxygen, air and sevoflurane with minimum alveolar concentration 1–1.1. The tethered cord was separated, large dural defect was repaired using dorsolumbar fascia, and a theco-peritoneal shunt was placed.

Subcutaneous emphysema - An unexpected cause for respiratory distress during vitreoretinal surgery under peribulbar block

A 65-year-old-male with cataract and vitreous haemorrhage in the left eye was scheduled for phacoemulsion and vitrectomy under peribulbar block. He had no other co-morbid illness. After attaching monitors (electrocardiogram, non-invasive blood pressure and pulse-oximetery probe), the ophthalmic resident performed left eye peribulbar block with 5 ml 2% lignocaine and 5 ml 0.5% bupivacaine at inferotemporal and medial region.

Evaluation of optimum time for intravenous cannulation after sevoflurane induction of anesthesia in different pediatric age groups

Background and Aims: The ideal time for intravenous (IV) cannulation following inhalational induction in children is debatable. The effect of age on this time has not been studied. We evaluated the optimum time for IV cannulation after sevoflurane induction of anesthesia in different pediatric age groups. Material and Methods: A prospective interventional study based on Dixons sequential up and down method was conducted in children of age 1–10 years. They were grouped according to their age – Group 1: 1–3 years, Group 2: >3–7 years, and Group 3: >7–10 years. Anesthesia was induced with 8% sevoflurane in 5 L of 100% oxygen. IV cannulation was attempted at 3.5 min in the first child in each group. The time for cannulation in the next child was stepped up or down by 30 s depending on positive or negative response, respectively, in the previous child. Children were recruited till a minimum of six pairs of failure–success sequence which was obtained in each group. The mean of midpoints of the failure–success sequence was calculated to obtain the time for cannulation in 50% of the children in each group. Results: Total number of children in Groups 1, 2, and 3 were 24, 23, and 24, respectively. The mean (95% confidence level) time for IV cannulation after sevoflurane induction in Groups 1, 2, and 3 was 53.6 (40.0–67.1), 105 (62.6–147.4), and 143.6 (108.8–178.4) s, respectively. This time was significantly shorter in Group 1 compared to those in Groups 2 and 3. Conclusion: The optimum time for IV cannulation in 50% of the children after sevoflurane induction of anesthesia was shorter in children of age 1–3 years than in older children.

Unfavourable outcome after uneventful anaesthesia and surgery in a child with Hurler syndrome

1. Blanco R. The ‘PECS block’: A novel technique for providing analgesia after breast surgery. Anaesthesia 2011;66:847-8. 2. Bouzinac A, Brenier G, Dao M, Delbos A. Bilateral association of pecs I block and serratus plane block for postoperative analgesia after double modified radical mastectomy. Minerva Anestesiol 2015;81:589-90. How to cite this article: Tewari S, Dhiraaj S, Sachan V, Bhargava T, Verma A. Ultrasound as a point-of-care tool for early detection of potential complications like pneumothorax associated with the pectoralis block. Indian J Anaesth 2017;61:852-3.