Balanced hydroxyethyl starch solution and hyperglycaemia in non diabetics - a prospective, randomized and controlled study.

BACKGROUND: There are very few studies that have examined the effect of hydroxyethyl starch (HES) solutions on blood glucose level. The study was aimed to compare the effects on blood glucose levels in patients undergoing lower limb surgeries under neuraxial block, receiving HES with those receiving 0.9% saline. PATIENTS AND METHODS: 160 non-diabetic ASA I or II patients, aged between 18-65 years were selected for the trial. Patients were divided into two groups; Group C (n = 80, patients received only 0.9% saline for preloading and maintenance until six hours of the end of preloading) and Group T (n = 80, patients received Tetraspan™ 10 mL kg⁻¹, for preloading and 0.9% saline for maintenance until six hours from the end of preloading). Blood glucose was recorded prior to the start of preloading and repeated at two, four and six hours after the end of HES infusion or the preloading dose of 0.9% saline. RESULTS: The following blood glucose levels were comparable at all times; fasting/baseline (85.3 ± 19.2 mg dL⁻¹ in group C and 95.4 ± 17.3 mg dL⁻¹ in group T); increase in blood glucose concentration at 2 hours (6.44 ± 20.59 mg dL⁻¹ in group C and 10.8 ± 18.1 mg dL⁻¹ in group T); 4 hours (4.1 ± 12.1 mg dL⁻¹ in group C and 3.5 ± 11.8 mg dL⁻¹ in group T); and at 6 hours (2.9 ± 13.4 mg dL⁻¹ in group C and 3.5 ± 10.6 mg dL⁻¹ in group T). CONCLUSION: A balanced HES solution administered intravenously did not cause an increase in blood glucose concentrations compared to those who received 0.9% saline.

Hyperglycaemia and ketosis in a non-diabetic patient--an unusual cause of delayed recovery.

We report a case of hyperglycaemia and ketosis developing in a non-diabetic patient who underwent a neurosurgical procedure under general anaesthesia. A 52-year-old non-diabetic female patient underwent excision of acoustic neuroma under general anaesthesia. Pancreatic function was not disturbed and she received a single dose of dexamethasone (8 mg) and paracetamol (1 g). Delayed recovery from anaesthesia occurred. On investigation, she was found to have hyperglycaemia and ketosis. She was further managed on the line of diabetic ketoacidosis. After 24 hours, when blood glucose had normalised and ketosis abated, she could be weaned from mechanical ventilation and extubated. The patient did not receive any drugs known to cause such a condition. To the best of our knowledge, hyperglycaemia and ketosis developing in a non-diabetic patient causing delayed recovery and extubation is here reported for the first time.

Dexmedetomidine overdosage: An unusual presentation.

We present a case of dexmedetomidine toxicity in a 3-year-old child. The case report describes the features and outlines the treatment strategy adopted. The child presented with bradypnoea, bradycardia, hypotension, deep hypnosis and miosis. He was successfully managed with oxygen, saline boluses and adrenaline infusion. He became haemodynamically stable with adrenaline infusion. He started responding to painful stimuli in 3 h and became oriented in 7 h. Dexmedetomidine, a selective α2 adrenoceptor agonist, is claimed to have a wide safety margin. This case report highlights the fact that dexmedetomidine administered in a toxic dose may be life-threatening may present with miosis and adrenaline infusion may be a useful supportive treatment.

Anaesthetic complications in plastic surgery.

Anaesthesia related complications in plastic surgeries are fortunately rare, but potentially catastrophic. Maintaining patient safety in the operating room is a major concern of anaesthesiologists, surgeons, hospitals and surgical facilities. Circumventing preventable complications is essential and pressure to avoid these complications in cosmetic surgery is increasing. Key aspects of patient safety in the operating room are outlined, including patient positioning, airway management and issues related to some specific conditions, essential for minimizing post-operative morbidity. Risks associated with extremes of age in the plastic surgery population, may be minimised by a better understanding of the physiologic changes as well as the pre-operative and post-operative considerations in caring for this special group of patients. An understanding of the anaesthesiologist's concerns during paediatric plastic surgical procedures can facilitate the coordination of efforts between the multiple services involved in the care of these children. Finally, the reader will have a better understanding of the perioperative care of unique populations including the morbidly obese and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patients' experience and surgical outcome.