Anesthesia, essays and researches
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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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The aim of this study was to determine the incidence of early postoperative hypoxia after general anesthesia and to evaluate the need of oxygen supplementation. A total of 150 patients aged between 18-60 years belonging to ASA I or II were studied. Patients were alternately allocated to two groups of 75 each. ⋯ Group-II (n=75) patients did not receive oxygen either during transfer or in the recovery room. Twenty percent in Group-II developed hypoxaemia during transfer from operation theatre to recovery room out of which 24% developed mild (SaO2 86-90%), 2.66% moderate (SaO2 85-81%), and 1.33% extreme (SaO2 <76%) hypoxaemia. None of the patients in Group - I, who received oxygen supplementation, developed hypoxaemia in the early postoperative period.
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Postoperative pain has a significant impact on patient's recovery and optimal nonopioid analgesia would reduce postoperative pain and pain-related complications. This study was aimed to evaluate the analgesic efficacy and safety of intravenous paracetamol versus parecoxib for postoperative analgesia after surgery. ⋯ Postoperative nonopioid intravenous analgesia with paracetamol and parecoxib is comparable in the early postoperative period with no adverse effects.
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Though rocuronium has a rapid onset of neuromuscular blockade like succinylcholine without the latter's adverse effects, its use is limited due to its prolonged action. ⋯ Rocuronium in dose of 0.3 mg/kg does not give clinically acceptable intubating conditions at 60 or 90 s but has shorter duration of action. Rocuronium in dose of 0.6 mg/kg gives clinically acceptable intubating conditions at 60 or 90 s, comparable to succinylcholine 1 mg/kg.
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Ultrasound-guided sciatic nerve block, in combination with femoral nerve and lateral femoral cutaneous nerve blocks, is frequently used to induce anesthesia for lower limb surgery. The anterior approach to the sciatic nerve is performed in the supine position and repositioning of the patient between injections is avoidable. We compared the relative utility and efficiency of anterior versus transgluteal sciatic nerve blocks in conjunction with femoral nerve and lateral femoral cutaneous nerve blockade. ⋯ Ultrasound-guided anterior blockade of the sciatic nerve has advantages over the transgluteal approach - it provides efficient anesthesia and results in excellent patient satisfaction.