Journal of anaesthesiology, clinical pharmacology
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J Anaesthesiol Clin Pharmacol · Jul 2014
Spinal anesthetic for emergency cesarean section in a parturient with uncorrected tetralogy of Fallot, presenting with abruptio placentae and gestational hypertension.
A subarachnoid block is an effective way of providing anesthesia for cesarean sections. However, it can be considered relatively contra-indicated in parturients with uncorrected tetralogy of Fallot (TOF). ⋯ The surgery was successfully conducted under a spinal anesthetic with a combination of low dose bupivacaine and fentanyl. Fentanyl combined with small-dose bupivacaine in the subarachnoid space can be considered as an alternative technique to general anesthesia, in selected parturients with uncorrected TOF presenting for cesarean section, especially in cases where the risks of administering a general anesthetic are deemed high.
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J Anaesthesiol Clin Pharmacol · Jul 2014
Evaluation of endotracheal intubating conditions without the use of muscle relaxants following induction with propofol and sevoflurane in pediatric cleft lip and palate surgeries.
Children with facial clefts are usually difficult to intubate and it is considered safer to keep them spontaneously breathing while securing the airway. This prospective comparative study was conducted to evaluate endotracheal intubating conditions in pediatric patients undergoing cleft surgeries, without the use of muscle relaxants following induction with propofol and sevoflurane. ⋯ Sevoflurane 8% in oxygen provides clinically acceptable intubating conditions without use of muscle relaxants in pediatric cleft patients.
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J Anaesthesiol Clin Pharmacol · Jul 2014
Benefits of intravenous lidocaine on post-operative pain and acute rehabilitation after laparoscopic nephrectomy.
Intravenous (I.V.) lidocaine has analgesic, antihyperalgesic and anti-inflammatory properties and is known to accelerate the return of bowel function after surgery. We evaluated the effects of I.V. lidocaine on pain management and acute rehabilitation protocol after laparoscopic nephrectomy. ⋯ Intravenous (I.V.) lidocaine could reduce post-operative morphine consumption and improve post-operative pain management and post-operative recovery after laparoscopic nephrectomy. I.V. lidocaine could contribute to better post-operative rehabilitation.
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J Anaesthesiol Clin Pharmacol · Jul 2014
Entropy as an indicator of cerebral perfusion in patients with increased intracranial pressure.
Changes in electroencephalogram (EEG) patterns correlate well with changes in cerebral perfusion pressure (CPP) and hence entropy and bispectral index values may also correlate with CPP. To highlight the potential application of entropy, an EEG-based anesthetic depth monitor, on indicating cerebral perfusion in patients with increased intracranial pressure (ICP), we report two cases of emergency neurosurgical procedure in patients with raised ICP where anesthesia was titrated to entropy values and the entropy values suddenly increased after cranial decompression, reflecting the increase in CPP. Maintaining systemic blood pressure in order to maintain the CPP is the anesthetic goal while managing patients with raised ICP. EEG-based anesthetic depth monitors may hold valuable information on guiding anesthetic management in patients with decreased CPP for better neurological outcome.
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J Anaesthesiol Clin Pharmacol · Jul 2014
Transversus abdominis plane block as the primary anesthetic for laparotomy.
Elderly patients undergoing emergency intra-abdominal surgery are at high risk for morbidity and mortality. The risks and side-effects associated with intubation and mechanical ventilation or neuraxial anesthesia must be balanced against the need to maintain hemodynamic stability while maximizing pain control. ⋯ We present three cases of ultrasound guided transversus abdominis plane (TAP) block as the primary anesthetic for laparotomy in elderly patients with multiple comorbidities. We have demonstrated the efficacy of and recommend the use of TAP blocks as the primary surgical anesthetic in a selected group of patients undergoing laparotomy.