Giant Haemangioma Excision Under Cervical Epidural Anaesthesia: A Viable Alternative to General Anaesthesia.

The cervical epidural anaesthesia is a safe anaesthetic technique with minimal morbidity and early postoperative recovery. Cervical epidural anaesthesia can be effectively used for neck, upper arm and chest surgeries. The technique avoids the adverse effects of general anaesthetics and airway instrumentation, especially in patients with cardio respiratory disorders. We preferred CEA for giant haemangioma neck excision in an adult female patient, having an associated laryngeal haemangioma, 10ml of 0.5% ropivacaine with 50µg Fentanyl (total 11 ml) was administered into the cervical epidural space through a 20G epidural catheter introduced via a 18G Tuohy needle at the level of C7-T1 space. Following initial dose a top up dose of 4ml 0.5% Ropivacaine was given after 60 minutes. The surgery lasted for 75 minutes. The cervical epidural anaesthesia allowed our patient to stay awake but comfortable, with stable haemodynamics and excellent postoperative pain relief with a continuous cervical epidural infusion of 0.25% Ropivacaine and 2µg/ml Fentanyl @ 2ml/h was achieved.

To evaluate the efficacy of intrathecal magnesium sulphate for hysterectomy under subarachnoid block with bupivacaine and fentanyl: A prospective randomized double blind clinical trial.

BACKGROUND: Intrathecal magnesium has been found to prolong the duration of analgesia in various surgical procedures like lower limb surgeries and as adjuncts to general anesthesia for pain management. The present study was designed to examine whether addition of intrathecal magnesium sulfate would enhance the analgesic efficacy of intrathecal bupivacaine and fentanyl in patients undergoing total abdominal hysterectomy. METHODS: After taking informed consent, 60 patients were randomised into two groups with 30 patients. Group "S" received 2.5 mL (12.5 mg) of hyperbaric bupivacaine + 0.5 mL (25 mcg) of fentanyl + 0.5 mL of normal saline and Group "M" received 2.5 mL (12.5 mg) of hyperbaric bupivacaine + 0.5 mL (25 mcg) of fentanyl + 0.5 mL (100 mg) of magnesium sulfate. Onset of sensory, motor block and duration of analgesia was noted. RESULTS: Demographic profile and duration of surgery were comparable (P>0.5). Time of onset of sensory and motor blockade was delayed in Group M compared with Group S, and this was statistically significant. A statistically significant longer duration of analgesia was observed in Group M compared with the control Group S. However, the recovery of motor blockade was found to be statistically insignificant in both the groups. The hemodynamic parameters were comparable in the perioperative period (P>0.05). The incidence of side-effects in both the groups were also comparable (P>0.05). CONCLUSION: The addition of 100 mg intrathecal magnesium led to prolonged duration of analgesia significantly without increasing the incidence of side-effects. Also, there was a significant delay in the onset of both sensory and motor blockade.

Spinal cord imaging by transesophageal echocardiography: a new modality of monitoring.

A 45-year-old patient with known history of Aortic arch aneurysm presented in the emergency ward with features of rupture of the aneurysm into the left lung with compressive signs in the pulmonary parenchyma. Diagnosis was confirmed by magnetic resonance imaging. The patient underwent repair of thoracic aortic aneurysm with left upper lobectomy under general anesthesia and cardio-pulmonary bypass support. Transesophageal echocardiography (TEE) was used for an intraoperative monitoring. While imaging the thoracic aorta with TEE was underway, we accidentally visualized an image that was confirmed to be the spinal cord. So, in this article we discuss how the spinal cord monitoring can be made possible with TEE.

Congenital lobar emphysema in neonates: Anaesthetic challenges.

Congenital lobar emphysema (CLE) is a potentially reversible, though possibly life-threatening, cause of respiratory distress in the neonate. It poses dilemma in diagnosis and management. We are presenting a 6-week-old baby who presented with a sudden onset of respiratory distress related to CLE affecting the left upper lobe. Lobectomy was performed under general anaesthesia with one lung ventilation. The details of anaesthetic challenges and management are described here.

A large angiosarcoma of the right atrium: anaesthetic management.

We present the case of a young man diagnosed with a right atrial mass and a large pericardial effusion. The patient had presented in the emergency department with chest pain, shortness of breath, pedal oedema and loss of appetite. A transthoracic echocardiogram showed a bright echodensity in the right atrium with a large pericardial effusion. He was treated for presumed tubercular pericardial effusion. Pericardiocentesis showed a straw-coloured non-tubercular pericardial effusion. Surgical removal of the right atrial tumour was planned with cardiopulmonary bypass support. The tumour could only be partially resected due to large adhesions with the myocardium. The patient suffered a cardiorespiratory arrest in the intensive care unit 3 hours after surgery due to persistent bleeding in the pericardial cavity with refractory hypovolemic shock and could not be revived. The pathological examination performed later revealed a primary cardiac angiosarcoma. The case highlights the initial clinical presentation, current diagnostic modalities, and anaesthetic management options for cardiac angiosarcoma.

Eisenmenger's syndrome in pregnancy: use of Proseal laryngeal mask airway (PLMA) and epidural analgesia for elective cesarean section.

We describe the successful anesthetic management of cesarean section in a patient with Eisenmenger's syndrome secondary to an atrial septal defect. Although conception is discouraged in women with Eisenmenger's syndrome, in inevitable circumstances, careful and meticulous planning of anesthesia can help the parturient survive the ordeal of a cesarean section. The cardiac output must be maintained and systemic vascular resistance must not be allowed to fall. This should ensure that there is minimal change in the right to left shunt. In our patient, the scenario of Eisenmenger's syndrome was complicated by biventricular hypertrophy. We achieved the goals in our patient by using general anesthesia with the Proseal laryngeal mask airway, a combination of ketamine and propofol, and epidural analgesia.