Indian journal of anaesthesia
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Shivering-the "Big Little Problem" has an incidence of 60% in early recovery phase following general anaesthesia. A number of techniques have been tried to prevent postoperative shivering. Previous study showed that, ondansetron in higher doses reduces postoperative shivering. ⋯ Groups P and G differ significantly than in Group S (p<0.05). However, the difference between Groups P and G was not statistically significant (p>0.05). The prophylactic use of granisetron (40mcg.kg(-1)) and pethidine(25mg) intravenous were found to be effective in preventing postoperative shivering.
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Carotid endarterectomy(CEA) is being increasingly performed under regional anaesthesia supplemented with sedation, the world over. Deep or superficial cervical plexus blocks or a combination of both have been found to be equally effective. ⋯ These are especially useful given the varying landmarks quoted by various authors as also inter-individual differences in anatomy. We present a case report of how fluoroscopy aided us in administering cervical plexus block.
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Awareness is the postoperative recall of sensory perception during general anaesthesia. The incidence is quoted at 1-2 per every 1000 patients. This rare but serious adverse event can be extremely distressing for both the patient as well as the anaesthesiologist. ⋯ This article addresses the various contributory factors that may predispose to intra-operative awareness. Preventive measures in the preinduction period as well as intraoperatively are discussed, including the use of depth of anaesthesia monitors. Remedial steps to be taken when such an event occurs are also discussed.
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Laryngeal mask airway (LMA) is increasingly being used in children as it is less invasive compared to endotracheal intubation and causes less discomfort in the postoperative period. However, some concerns remained about its safety during positive pressure ventilation in children. In a prospective randomized trial, 100 ASA I and II children weighing between 10-20 kg in the range of 2-10 years of age, scheduled for elective surgery were randomly allocated to one of the two groups of 50 patients each. ⋯ Furthermore these changes persisted for longer duration after endotracheal intubation in comparison to LMA insertion (5 min vs 3 min). Incidence of postoperative complications i.e. bronchospasm, laryngospasm and soft tissue trauma was significantly higher (p<0.05) after endotracheal intubation as compared to LMA insertion. To conclude, the laryngeal mask airway is a suitable alternative to endotracheal intubation for positive pressure ventilation in children.
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Cardiovascular collapse following use of methylmethacrylate for lower limb surgeries has been reported. However there are no reports of cement reaction following shoulder arthroplasty. We report series of four patients exhibiting cement reaction. ⋯ Severe hemodynamic derangement and transient hypoxemia was observed during cemented arthroplasty of shoulder and knee respectively. Peripheral vasodilatory effects of the cement monomer, fat and marrow embolism and activation of the clotting cascade in the lungs, all contribute to cement reaction. Early and aggressive resuscitation with use of vasopressors, establishment of invasive hemodynamic monitoring and surgical modifications are the key to prevention of catastrophic outcome.