Indian journal of anaesthesia
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Cardiovascular collapse following use of methylmethacrylate for lower limb surgeries has been reported. However there are no reports of cement reaction following shoulder arthroplasty. We report series of four patients exhibiting cement reaction. ⋯ Severe hemodynamic derangement and transient hypoxemia was observed during cemented arthroplasty of shoulder and knee respectively. Peripheral vasodilatory effects of the cement monomer, fat and marrow embolism and activation of the clotting cascade in the lungs, all contribute to cement reaction. Early and aggressive resuscitation with use of vasopressors, establishment of invasive hemodynamic monitoring and surgical modifications are the key to prevention of catastrophic outcome.
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The aim of the study was to assess and compare laryngoscopic view of Truview evo2 laryngoscope with that of Macintosh laryngoscope in patients with one or more predictors of difficult intubation (PDI). Moreover ease of intubation with Truview evo2 in terms of absolute time requirement was also aimed at. Patients for elective surgery requiring endotracheal intubation were initially assessed for three PDI parameters - modified Mallampati test, thyro-mental distance & Atlanto-occipital (AO) joint extension. ⋯ Intubation with Truview evo2 was possible in 88% cases within stipulated time of one minute and mean time of 28.6 seconds with SD of 11.23 was reasonably quick. No significant complication like oro- pharyngeal trauma or extreme pressor response to laryngoscopy was noticed. To conclude, Truview evo2 proved to be a better tool than conventional laryngoscope in anticipated difficult situations.
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Chronic low back pain (CLBP) is challenging to treat with its significant psychological and cognitive behavioural element involved. Mindfulness meditation helps alter the behavioural response in chronic pain situations. ⋯ The current evidence in the field, though not grade one, shows that there is a place for mindfulness meditation in managing chronic pain conditions including CLBP. Further research to test the usefulness of mindfulness in CLBP should involve good quality randomized controlled trials of pure mindfulness based technique in matched subjects.
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Awareness is the postoperative recall of sensory perception during general anaesthesia. The incidence is quoted at 1-2 per every 1000 patients. This rare but serious adverse event can be extremely distressing for both the patient as well as the anaesthesiologist. ⋯ This article addresses the various contributory factors that may predispose to intra-operative awareness. Preventive measures in the preinduction period as well as intraoperatively are discussed, including the use of depth of anaesthesia monitors. Remedial steps to be taken when such an event occurs are also discussed.
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Laryngeal mask airway (LMA) is increasingly being used in children as it is less invasive compared to endotracheal intubation and causes less discomfort in the postoperative period. However, some concerns remained about its safety during positive pressure ventilation in children. In a prospective randomized trial, 100 ASA I and II children weighing between 10-20 kg in the range of 2-10 years of age, scheduled for elective surgery were randomly allocated to one of the two groups of 50 patients each. ⋯ Furthermore these changes persisted for longer duration after endotracheal intubation in comparison to LMA insertion (5 min vs 3 min). Incidence of postoperative complications i.e. bronchospasm, laryngospasm and soft tissue trauma was significantly higher (p<0.05) after endotracheal intubation as compared to LMA insertion. To conclude, the laryngeal mask airway is a suitable alternative to endotracheal intubation for positive pressure ventilation in children.