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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Unanticipated difficult intubations on the operation table have often tested all the anesthetists' intubation skill. The understanding of the causative factor and accordingly using the correct instrument from the difficult intubation kit requires experience and thorough knowledge on the part of the anesthetist. We describe a case of difficult intubation due to scar contracture of anterior tonsillar pillar formed after a previous surgery.
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The anesthesiologist is frequently involved in the task of achieving central venous access either for intraoperative uses or postoperative purposes or Intensive Care Unit care. We are usually aware of the common complications of subclavian approach, such as arterial puncture, bleeding, pneumothorax, misplacement in the ipsilateral internal jugular vein (IJV) or contralateral brachiocephalic or subclavian vein. In this case report, we highlight the possibility of malpositioning of central venous cannula inserted through IJV into the anterior extra pleural plane after failed subclavian cannulation attempts.
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Rocuronium (R) bromide and vecuronium (V) are monoquaternary aminosteroid compounds. The aim of this study was to evaluate the onset time, conditions of intubation and duration of action of equipotent doses (3ED95) of R and V. ⋯ At equipotent doses, R provides clinically acceptable intubation conditions much earlier than V without significant variation in clinical duration of action.