Tanmoy Ganguly

Comparison of the Hemodynamic Alterations in Normotensive and Preeclamptic Pregnant Woman Posted for Cesarean Section Under Subarachnoid Block

Introduction: Anesthesia for cesarean section in a patient with preeclampsia is far more complicated than an otherwise normal pregnancy for several reasons. Apart from the risks of high incidence of intrauterine growth restriction, fetal distress and prematurity, there are risk of increased perioperative morbidity due to altered hemodynamics nMaterial and methods: This study was conducted on 100 booked pregnant woman of ASA physical status I and II (Normotensive) or III (Preeclamptic), between 19 to 30 years of age, carrying a live, mature, healthy, single fetus posted for elective cesarean section. Patients were counseled during preoperative examination and 50 normotensive and 50 preeclamptic patients were recruited for this study after obtaining informed consent from each of the patient in their own language. nResult and Analyses: In this study, the authors found significant differences in SBP, DBP and MAP at different point of times in both the groups. One probable explanation of this may be the use of invasive arterial blood pressure monitoring in place of non-invasive monitoring unlike other studies. Also the preoperative blood pressure values were significantly different in both the groups. More phenylephrine consumption was noted in the normotensive group. nConclusion: subarachnoid block in preeclampsia patients associated with better perioperative hemodynamic stability, less hypotension, less vasopressor consumption and more gradual blood pressure changes.

Cardiovascular and Airway Considerations in Mediastinal Mass During Thoracic Surgery

Mediastinal Masses have always posed as a nightmare even for the skilful anaesthesiologists. The compression effects, the proximity to major vascular and airway structures, the complex surgical approaches has altogether made both the diagnostic and therapeutic procedures a high risk event. The scenario is more troublesome if the patient is an infant or child. Here the anaesthesiologists has almost no information regarding ‘Position of airway rescue’ or ‘Position of maximum airway patency’ to which he can put the patient in case of any therapeutic misadventure arising out of compressive effect of the mediastinal mass on the airway and/or great vessels once the patient is induced or in the way of being induced for anaesthesia.

Peripheral Nerve Sheath Tumour of Neck: A Rare Presentation a Case Report

Malignant peripheral nerve sheath tumour (MPNST) is a rare and very aggressive tumour of nerve cell origin associated with poor prognosis. Incidence of MPNST is 1 per 1, 00,000 populations and it constitutes between 3%-10% of all soft tissue sarcomas1-4. MPNST have been found to be associated with neurofibromatosis type 1 (associated with mutation in NF-1 gene) in 2%-29% cases . Male and female are almost equally (53:47) involve. These tumours often create diagnostic dilemmas because of non-specific clinical diagnostic criteria, histopathological resemblance with other spindle cell sarcomas like monophasic synovial sarcoma, leiomyosarcoma and fibrosarcoma.

Variability of Presentation and Surgical Approach in Patients withCongenital Cystic Adenomatoid Malformation: Report of Two Cases

Congenital cystic adenomatoid malformation (CCAM) is a rare hypoplastic, dysplastic or hamartomatous disorder of lung. Two such cases were referred to our institute and managed surgically. The first case, a 4 month old male baby diagnosed antenatally with cystic lesions in the lung and suffered from respiratory tract infection postnatally. A computerised tomography scan (CT scan) was done to assess area of involvement in the lung. As apical and anterior basal segment (Segment 6 and 7) was found to be involved, segmentectomy was performed. The second patient, a 2 month old female baby, presented with features of pneumothorax with a normal perinatal history. CT scan revealed multiple cystic lesions of different sizes involving whole left lobe. Left lower lobectomy was performed. The authors emphasize on postnatal confirmation of CCAM by CT scan and lobectomy or segmentectomy as early as possible after 1 month of age guided by CT scan and thoracotomy finding even in asymptomatic patient.