Laparoscopic appendicectomy in a postpneumonectomy patient.

Pneumoperitoneum for laparoscopic surgeries has anesthetic implications due to increase in the intra-abdominal pressure and end-tidal carbon dioxide. The effects are more pronounced if the patient has only one lung. However, the advantages of laparoscopy include reduced postoperative pain and early recovery. We present a case of 30-year-old patient who had undergone pneumonectomy and was posted for laparoscopic appendicectomy. General anesthesia was instituted, and with some modifications in ventilation, the procedure was uneventful and we were able to extubate the patient on the table. Understanding of the physiological consequences of pneumonectomy facilitated the provision of safe anesthesia.

Résumé Le pneumopéritoine pour les chirurgies laparoscopiques a des implications anesthésiques en raison de l'augmentation de la pression intra-abdominale et du dioxyde de carbone en fin d'expiration. Les effets sont plus prononcés si le patient n'a qu'un seul poumon. Cependant, les avantages de la laparoscopie comprennent une réduction de la douleur postopératoire et une récupération précoce. Nous présentons un cas de patient de 30 ans ayant subi une pneumonectomie et posté pour une appendicectomie laparoscopique. Une anesthésie générale a été instituée, et avec quelques modifications de ventilation, la procédure s'est déroulée sans incident et nous avons pu extuber le patient sur la table. La compréhension des conséquences physiologiques de la pneumonectomie a facilité la fourniture d'une anesthésie sûre. Mots-clés: Appendicectomie, laparoscopie, pression maximale des voies respiratoires, pneumonectomie.

Anesthetic management of a patient presenting with huge neck lymphatic cyst.

Lymphatic cyst in the cervical region presents a great challenge to the anesthesiologist. The anesthetic difficulties are because of the extension of the cyst, difficult airway, postoperative respiratory obstruction, and coexisting anomalies. The management of such patients depends on direct communication between the surgeon and anesthesiologist. We hereby present a case of a 53-year-old male presenting with lymphatic cyst of the cervicothoracic region with dysphagia and dyspnea, posted for direct laryngoscopy and biopsy under general anesthesia. Awake fiberoptic intubation was done in this patient successfully in spite of totally distorted airway anatomy.

Résumé Le kyste lymphatique dans la région cervicale présente un grand défi pour l'anesthésiste. Les difficultés anesthésiques sont dues à l'extension du kyste, des voies respiratoires difficiles, une obstruction respiratoire postopératoire et des anomalies coexistantes. La prise en charge de ces patients dépend de communication directe entre le chirurgien et l'anesthésiste. Nous présentons ici le cas d'un homme de 53 ans présentant une atteinte lymphatique kyste de la région cervicothoracique avec dysphagie et dyspnée, posté pour laryngoscopie directe et biopsie sous anesthésie générale. Éveillé l'intubation par fibre optique a été réalisée avec succès chez ce patient malgré une anatomie des voies respiratoires totalement déformée. Mots-clés: Hygroma kystique, voies aériennes difficiles, intubation fibre optique.

Effect of Different Dosages of Intravenous Midazolam Premedication on Patients Undergoing Head and Neck Surgeries- A Double Blinded Randomized Controlled Study.

INTRODUCTION: Benzodiazepines primarily acts on the central nervous system. Most patients are extremely anxious in the pre-operative period. Excessive anxiety adversely influences anaesthetic induction and often leads to functional impairment and poor recovery after surgery. AIM: To determine whether amnesia, anxiety, sedation and cardio respiratory symptoms are affected while administering two different doses of intravenous midazolam (0.02 mg/kg & 0.06 mg/kg). MATERIALS AND METHODS: Two forty patients posted for head and neck surgeries were involved in this double blinded prospective randomised controlled trial. The patients were randomized into two main groups, Group 1 receiving 0.02 mg/kg and Group 2 receiving 0.06 mg/kg midazolam intravenously as premedication. Visual recognition and recall were tested using eight laminated A4 size posters pre-operatively and four further images were shown at the postoperative interview. Anxiety was evaluated by a Visual Analogue Scale (VAS) and sedation depth was determined by the Observer's Assessment of Alertness/Sedation Scale (OAAS) scale. Vital signs including heart rate, respiratory rate, mean blood pressure and arterial oxygen saturation (SpO2) were monitored. Statistical analysis was done using paired Student's t-test and Chi-square test. RESULTS: VAS scores were lower in Group 2 (0.06 mg/kg) than in Group 1 (0.02 mg/kg) at T15 (15 minutes after the injection of midazolam). Comparison of OAAS scores among Group 1 and Group 2 showed that more patients in Group 1 were alert at T15 compared to Group 2. Recall of events was significantly lower in Group 2 compared to Group 1. There was no significant statistical variation in haemodynamic parameters between the groups except for decreased diastolic blood pressure and room air saturation in Group 2. CONCLUSION: A higher dosage of midazolam improves the quality of anxiolysis and sedation with lesser rates of intraoperative recall and maintains haemodynamic stability.