Anesthesia, essays and researches
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Case Reports
Epidural catheter misplaced into the thoracic cavity: Utilized to provide interpleural analgesia.
Thoracic epidural analgesia is one of the most effective and time-tested modalities of providing postthoracotomy pain relief. It improves postoperative pulmonary outcome. Nevertheless, being a blind procedure several complications have been associated with the technique. ⋯ We have discussed a patient who underwent a right thoracotomy for excision of emphysematous bulla of lung under general anesthesia with thoracic epidural. The epidural catheter was misplaced in the pleural cavity and was detected intraoperatively after thoracotomy. The catheter was left in situ and was successfully utilized to provide postoperative analgesia via the interpleural route.
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To date, racemic bupivacaine is the most popular local anesthetic for spinal anesthesia in parturients undergoing elective cesarean delivery. With the introduction of levobupivacaine as pure S (-) enantiomer of bupivacaine which offers advantages of lower cardiotoxicity and neurotoxicity and shorter motor block duration, its use has widely increased in India. However, very few studies have been conducted about its efficacy in obstetric anesthesia. Thus, this study was undertaken to compare the sensorial, motor block levels, and side-effects of equal doses of hyperbaric bupivacaine and levobupivacaine with intrathecal fentanyl addition in elective cesarean cases. ⋯ Intrathecal isobaric levobupivacaine-fentanyl combination is a good alternative to hyperbaric bupivacaine-fentanyl combination in cesarean surgery as it is less effective in motor block, it maintains hemodynamic stability at higher sensorial block levels.
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Maxillofacial trauma is an apt example of a difficult airway. The anesthesiologist faces challenges in their management at every step from airway access to maintenance of anesthesia and extubation and postoperative care. ⋯ Maxillofacial injuries present a complex challenge to the anaesthesiologist. The fibreoptic bronchoscope is the main weapon available in our arsenal. The submental technique scores over the time-honored tracheostomy. Communication between the anaesthesiologist and the surgeon must be given paramount importance.
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The aim of the study was to compare postoperative pain relief in patients undergoing an elective thoracotomy with thoracic epidural analgesia using single shot magnesium and clonidine as adjuvants to bupivacaine. ⋯ Thoracic epidural analgesia using bupivacaine with clonidine is an efficient therapeutic modality for postthoracotomy pain. Magnesium as an adjuvant provided quality postoperative analgesia decreasing the need for postoperative rescue analgesia and incidence of postoperative shivering without causing sedation.
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Laryngoscopy and intubation cause an intense reflex increase in heart rate, blood pressure, due to an increased sympathoadrenal pressor response. Lignoocaine has shown blunting of pressor response to intubation. Dexmedetomidine has sympatholytic effects. ⋯ We conclude that dexmedetomidine 1μg/kg adequately attenuates the hemodynamic response to laryngoscopy and endotracheal intubation when compared with dexmedetomidine 0.5μg/kg and lignocaine 1.5mg/kg.