Shashi Kiran

Acute pansialadenopathy during induction of anesthesia causing airway obstruction

A healthy, 35-yr-old, 60-kg, 162cm woman with diffuse thyroid enlargement (3 X 3 cm) was scheduled for thyroidectomy. Thyroid function tests were within normal limits. Preoperative airway assessment revealed Mallampati class I and adequate hyoid-mentum distance. She had no known allergies and was not taking any medications. She was premedicated with meperidine 30 mg and promethazine 25 mg intramuscularly 45 min preoperatively. Induction of anesthesia was accomplished with atropine 0.3 mg and thiopental 250 mg intravenously (IV). Succinylcholine 100 mg IV was given to facilitate tracheal intubation. On laryngoscopy, only the epiglottis could be visualized (Cormack and Lehane grade III), and the trachea could not be intubated. The patient was ventilated via a mask; intubation with cricoid pressure was tried again, without success. Additional atropine 0.3 mg, thiopental 100 mg, and succinylcholine 50 mg were given IV to maintain anesthesia and to facilitate ventilation and laryngoscopy. The lungs could be ventilated easily. At this stage, progressively increasing bilateral swelling in the parotid and submandibular region was noticed, accompanied by profuse production of watery saliva. The nature of the mass was not consistent with muscular spasm, bony displacement, or an air-filled sac. On palpation, there was no crepitus or pulsations, and the swelling could not be reduced with pressure. Increasing difficulty in maintaining the airway occurred, despite the use of an oropharyngeal airway. There was stridor and decreasing oxygen saturation, although heart rate and blood pressure were stable. A larnygeal mask airway size 4 was inserted, but only slight ventilation was possible. In view of the progressive increase in

Obturator neurolysis using 65% alcohol for adductor muscle spasticity

Spasticity is motor alteration characterized by muscle hypertonia and hyperreflexia. It is an important complication of spinal cord injury, traumatic brain injury, cerebral palsy, and multiple sclerosis. If uncorrected, fibrosis and eventually bony deformity lock the joint into a fixed contracture. Chemical neurolysis using various agents is one of the therapeutic possibilities to alleviate spasticity. We are, hereby, reporting 3 patients in whom 65% alcohol was used as neurolytic agent for the treatment of hip adductor spasticity, and the effect lasted for a variable period.

Comparison of topical and intravenous lignocaine with thiopentone for insertion of laryngeal mask airway.

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Case study: An unusual cause of clotted blood in epidural catheter

Abstract The failure of an epidural catheter after initially functioning well may be due to kinking, knotting or epidural catheter lumen blockage. The presence of blood in the epidural catheter is usually due to the catheters traumatic placement or to intravascular migration. We describe an unusual cause of blood in the epidural catheter.

Airway obstruction following mandibular surgery - a case report

Upper airway obstruction may be due to loss of muscle tone of the upper airway, with mechanical obstruction from the tongue, or foreign bodies such as teeth, dentures, secretions or tumours present in the airway. Loss of skeletal muscle tone of the upper airway is related to the inhibition of the gamma motor neuron system, which results in relaxation of the tongue and pharyngeal constrictor muscles. At the level of the oral passage in the supine position, obstruction is usually as a result of the tongue falling back, at the level of the soft and partially the hard palate. Rarely, does the tongue fall into the pharynx. At the level of the pharynx, two mechanisms of obstruction may operate, which are independent of the position or movement of the tongue. It is due to the base of the epiglottis coming close to the rima glottidis, and the lateral parts of the epiglottis coming into contact with the posterior pharyngeal wall.