Anesthesia, essays and researches
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The study was undertaken to observe the effect of different maintenance-fluid regimen on intraoperative blood glucose levels in non-diabetic patients undergoing elective major non-cardiac surgery under general anesthesia. ⋯ We conclude that stress induced-hyperglycemic response in patients undergoing major non-cardiac surgery is common in non-diabetic population. Maintenance-fluid therapy by dextrose containing solution as opposed to Ringer's lactate solution increases the incidence of hyperglycemia. To achieve normoglycemia by intravenous bolus dose of human regular insulin, significantly higher doses are required in patients receiving dextrose containing saline as maintenance fluid.
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Supine emergence from anesthesia in patients undergoing lumbar surgery in prone position leads to tachycardia, hypertension, coughing, laryngospasm and loss of monitoring as the patients are rolled back to supine position at the end of surgery. The prone extubation might facilitate a smoother emergence because the patients are not disturbed during emergence and secretions are drained away from patient's airway. ⋯ In healthy normotensive patients, emergence from anesthesia in the prone position is associated with minimal hemodynamic change, and fewer incidences of coughing, laryngospasm, and monitor disconnections.
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Neuraxial blockade such as spinal anaesthesia can cause severe hypotension due to pharmacological sympathectomy resulting in potential deleterious consequences for the patient. Prevention of this spinal anaesthesia induced hypotension is of utmost importance especially in pregnant population as the life of mother as well as fetus is at risk. Several techniques and methodologies have been adopted for the prevention of this neuraxial hypotension with varying degree of success. ⋯ Numerous research studies and available literary evidence suggests that both of these techniques can be equally effective in prevention of hypotension. The use of colloids has been observed to be more effective for pre-loading due to their longer half-life in the intravascular compartment. However, it has also been suggested that no technique is efficient in preventing the hypotension alone and has to be coupled with judicious use of vasopressors.
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Case Reports
Anesthetic management in a patient with Wolff-Parkinson-White syndrome for laparoscopic cholecystectomy.
Wolff-Parkinson-White syndrome is an electrophysiological disorder of heart. Patients with such disorder may be asymptomatic or present with cardiac symptoms like palpitation and dyspnea. ⋯ We took all the precautions necessary to avoid tachycardia and arranged drugs necessary to treat any complications together with stringent monitoring which is very important for favorable outcome in these patients. Management of the case offers an opportunity to relearn the important considerations on WPW syndrome.