Prabhat Kumar Sinha

Anesthesia for awake craniotomy: A retrospective study

CONTEXTnAwake craniotomy is increasingly performed the world over. We share our experience of performing craniotomy awake with our anesthetic protocol.nnnAIMSnTo evaluate and analyze the anesthesia records of the patients who underwent awake craniotomy at our institution.nnnSETTINGS AND DESIGNnUniversity teaching hospital, Retrospective study.nnnMATERIALS AND METHODSnWe reviewed records of the 42 consecutive patients who underwent awake craniotomy under conscious sedation using Fentanyl and Propofol infusion until December 2005. The drugs were titrated (Bispectral monitoring was used in 16 patients) to facilitate intermittent intraoperative neurological testing. All patients received scalp blocks with a mixture of bupivacaine and lignocaine with adrenaline. Haloperidol and ondansetron were administered in all patients at induction of anesthesia.nnnRESULTSnAll patients completed the procedure. One patient each needed endotracheal intubation and LMA for airway control during closure, while another required CPAP perioperatively because of desaturation to <80%. There was significantly decreased use of anesthetics (P<0.001) and a trend towards reduction in complications (e.g. respiratory depression and deep sedation) (P>0.05) with the use of BIS as compared to without BIS. Intraoperative complications were hypertension (19%), tight brain (14.2%), focal seizure (9.5%) respiratory depression (7.1%), deep sedation (7.1%), tachycardia (7.1%) and bradycardia. Two patients desaturated to <95%. 23.8% patients developed transient neurological deficits. The most frequent postoperative complications were PONV (19%) and seizures (16.6%).nnnCONCLUSIONSnWith the use of advanced monitoring and newer anesthetics, awake craniotomy is a relatively safe procedure with an accepted rate of complications.

Nasogastric Tube Withdrawal: An Unusual Cause of Accidental Extubation and Near Cardiac Arrest in an Infant

I p NSERTING A NASOGASTRIC TUBE (NGT) is one of the most frequent procedures performed by anesthesiologists uring perioperative care of the patient. There have been nuerous reports of major complications resulting from NGT nsertion that include intracranial placement, digestive tract njury, misplacement to the trachea and lung with associated omplications, intussusception resulting in bowel obstruction, nd massive hemorrhage.1-6 Rare reports of airway compromise n adult patients after NGT insertion also have been reported.7-9 rare incident in which accidental extubation occurred while ithdrawing an NGT in an infant scheduled for cardiac magetic resonance imaging (cMRI) that resulted in rapid desatuation and near cardiac arrest is described, along with the ossible mechanisms and ways to prevent such incidents while nesthetizing an infant in such remote locations.

A Ring Artifact in the Left Ventricle on Transesophageal Echocardiography After Mitral Valve Replacement

A 48-year-old man, weighing 60 kg, underwent mitral valve replacement for severe mitral stenosis with a 29-mm St. Jude bileaflet mechanical prosthesis (St. Jude Medical, St. Paul, MN). We present the case after obtaining his consent. Transesophageal echocardiography (TEE) revealed that the mechanical prosthesis was working well after separation from cardiopulmonary bypass with minimal gradients and good ventricular function.

Embolization of Atrial Septal Occluder Device into the Pulmonary Circulation: Role of Transesophageal Echocardiography

(ECHOCARDIOGRAPHY, Volume 26, July 2009)

Accurate Localization and Echocardiographic-Pathologic Correlation of Tricuspid Valve Angiolipoma by Intraoperative Transesophageal Echocardiography

Angiolipoma (angiolipohamartoma) of the tricuspid valve (TV) is a rare tumor which may be occasionally misdiagnosed as right atrial (RA) myxoma. Transesophageal echocardiography (TEE) provides accurate information regarding the size, shape, mobility as well as site of attachment of RA tumors and is a superior modality as compared to transthoracic echocardiography (TTE). Correct diagnosis of RA tumors has therapeutic significance and guides management of patients, as myxomas are generally more aggressively managed than lipomas. We describe a rare case of a pedunculated angiolipoma of the TV which was misdiagnosed as RA myxoma on TTE and discuss the echocardiographic‐pathologic correlates of the tumor as well as its accurate localization by TEE. (ECHOCARDIOGRAPHY, Volume 26, November 2009)

Dual inferior venae cavae with mitral stenosis.

A 34-year old woman with rheumatic mitral stenosis was found to have complete dual inferior venae cavae with bilateral infrarenal and suprarenal segments, on balloon mitral valvuloplasty. The bilateral, renal, and gonadal veins drained separately on the ipsilateral side. The left inferior vena cava was larger than the right, and the right inferior vena cava had an aneurysmal dilatation near its origin. The left inferior vena cava drained into the superior vena cava-right atrial junction.

Case 2—2008 Rheumatic Mitral Stenosis Associated With Partial Anomalous Pulmonary Venous Return

i v 1 M HE ASSOCIATION OF partial anomalous pulmonary venous return (PAPVR) with atrial septal defect (ASD) is not nusual. Rarely, PAPVR of the left side or right side is assoiated with an intact atrial septum (IAS). The combination of cquired rheumatic mitral stenosis (MS) with PAPVR and IAS s very rare, and its pathophysiology is complex. The successful nesthetic management of an adult who presented for surgery or rheumatic MS and was incidentally found to have PAPVR f the left side with an IAS is presented here. Anesthetic mplications of such a rare combination of congenital and cquired heart disease are discussed.