Anesthesia, essays and researches
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It is difficult to predict the neurological outcome in survivor of cardio respiratory arrest. We report a case of 32 year old survivor of respiratory arrest who developed myoclonic jerks following overdose of sedation during spinal anesthesia. We initially thought these to be myoclonic status epilepticus (MSE). ⋯ Making an early diagnosis and properly managing LAS is positively related to improving the patient's functional outcome. The aim of this manuscript is to spread awareness and knowledge of LAS among ICU doctors. The diagnosis of LAS and the controversies and difficulties that surround its diagnosis and treatment and other aspects of prognostication in cardiac arrest are reviewed.
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Case Reports
Dextrocardia and ventricular septal defect with situs inversus: Anesthetic implications and management.
The patients with complicated congenital heart diseases are reaching adulthood with advances in corrective surgeries and medical management. Impact of anesthetic agents on complex cardiac and extra cardiac anomalies and presence of previous palliative procedures can be a challenge for the anesthesiologist perioperatively, while these patients present for cardiac/noncardiac surgeries. We report the perioperative management of a patient with ventricular septal defect, dextrocardia, pulmonary hypertension, and situs inversus who underwent a successful hernioplasty and hydrocelectomy with a combined spinal epidural anesthesia. This discussion relates to the anesthetic management in such conditions with a special reference to Kartagener's syndrome.
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Epidural volume extension (EVE) is claimed to increase the block height and decrease the dose requirement for intrathecal drug. However, almost all studies have been done in obstetric population and none actually compares the effect of additional drugs added to epidural volume. ⋯ EVE can increase the block height significantly, but it seems to be limited only to the physical property of additional volume in epidural space and fentanyl or tramadol do not seem to differ in their ability to alter block properties.
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Daily interruption of sedation could minimize the problem of sedatives accumulation. Nevertheless, whatever is the sedation strategy; sedation, particularly deep levels, has been associated with high frequency of patient-ventilator asynchrony. Extending these findings, one would expect that no sedation protocol could reduce the frequency of patient-ventilator asynchrony. ⋯ No sedation protocol reduces the asynchrony index and preserves the patient's effort during triggering.
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General anesthesia and neuraxial blockade have their own advantages and disadvantages over each other when used for hip surgery. Single shot lumbar plexus block can be the choice of the anesthetic technique for postrenal transplant, immunocompromised, postspinal surgery patient to undergo dynamic hip screw surgery.