Manoj K Sanwal

Abnormal oculocardiac reflex in two patients with Marcus Gunn syndrome

Marcus Gunn phenomenon is seen in 4 to 6% of congenital ptosis patients. We report two cases of abnormal oculocardiac reflex during ptosis correction surgery. Marcus Gunn syndrome is an autosomal dominant condition with incomplete penetrance. It is believed to be a neural misdirection syndrome in which fibres of the motor division of the trigeminal nerve are congenitally misdirected into the superior pterygoid and the levator muscles. Anesthetic considerations include taking a detailed history about any previous anaesthetic exposure and any reaction to it as this syndrome has a high probability of being associated with malignant hyperthermia. It is also postulated that an atypical oculocardiac reflex might be initiated in these patients as seen in our patients, so precautions must be taken for its prevention and early detection.

Acute pulmonary edema after intramyometrial prostodin

A 25 year old, 68 kg, primigravida, was taken up for emergency caesarean section for meconium stained liquor and fetal distress. She was a known case of pre eclampsia and her blood pressure was controlled on tab methyl dopa. she was administered general anaesthesia. after delivery of baby she went into postpartum hemorrhage which was controlled with intramyometrial prostodin. but immediately after its administration she went into acute pulmonary edema.

Awareness of basic life support among dental practitioners

Background: It is important that every member of our community should be trained in effective BLS technique to save lives. At least doctors including dental practitioners, and medical and paramedical staff should be trained in high quality CPR, as it is a basic medical skill which can save many lives if implemented timely. Aim: Our aim was to study the awareness of Basic Life Support (BLS) among dental students and practitioners in New Delhi. Materials and Methods: This cross sectional study was conducted by assessing responses to 20 selected questions pertaining to BLS among dental students, resident doctors/tutors, faculty members and private practitioners in New Delhi. All participants were given a printed questionnaire where they had to mention their qualifications and clinical experience, apart from answering 20 questions. Statistical Analysis: Data was collected and evaluated using commercially available statistical package for social sciences (SPSS version 12). Results: One hundred and four responders were included. Sadly, none of our responders had complete knowledge about BLS. The maximum mean score (9.19 ± 1.23) was obtained by dentists with clinical experience between 1-5 years. Conclusion: To ensure better and safer healthcare, it is essential for all dental practitioners to be well versed with BLS.

Caesarean section in a patient with Myasthenia Gravis: A bigger challenge for the anesthesiologist than the obstetrician

Myasthenia Gravis (MG) is an acquired, autoimmune disorder affecting neuromuscular junction presenting with easy fatigability, progressive weakness, diplopia, difficulty in speaking and swallowing and even ventilatory failure in severe cases. During pregnancy the disease may go into remission or may exacerbate at any time during first, second and third trimesters or postpartum period. We are reporting the case of a 28 year old primigravida, known case of MG, who underwent caesarean section and developed muscular weakness on third postoperative day. Her neonate also had tachypnoea and hypotonia, Both, the mother and the baby were managed aggressively and responded well to therapy.

Perioperative management of a patient with myxedema coma and septicemic shock

Myxedema coma is a life-threatening but uncommon complication of long-standing, neglected hypothyroidism. It was first reported by Ord in 1879. Till date only around 200 cases have been reported in literature. The incidence in European countries is 0.22 per million per year. No epidemiological data is available from the Indian subcontinent. We are reporting the case of an elderly lady who went into life-threatening myxedema coma along with septicemic shock, and was successfully treated with oral thyroxine.

Malfunctioning pilot balloon assembly

DOI: 10.4103/0970-9185.105828 the fluoroscopic technique for endobronchial intubation with a single lumen endotracheal tube quickly in infants. Fluoroscopic guidance allows manipulation of the DLT tip under direct visual control and observation of the DLT tip from various angles. Gentle handling should be used, while advancing the DLT, to prevent injury to the bronchial tree. Studies are recommended to determine the efficacy of the technique and evaluate the risks such as injury to the bronchus.

Anaesthetic challenges in a patient with Axenfeld Rieger Syndrome

The patient was a 3 year-old girl with no family history of ARS. She was first taken to ophthalmology clinic at 6 months of age when her parents noticed squinting of her eyes. Further workup confined the presence of glaucoma in both of her eyes. Slit lamp examination revealed a prominent Schwalbe’s line in all quadrants of both the eyes. There was no anomaly of the lens or fundus. A diagnosis of ARS was made.