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Snorkel breathing involves mouth breathing into a snorkel tube and is necessary for underwater activities. Anesthesiologists may have difficulty when dealing with adults who have a concomitant face mask and needle fear because both inhalation and intravenous induction cannot be performed. This case report describes a novel use of the snorkel breathing technique for anesthetic gas induction in an adult with face mask fear. A 24-year-old female with mask and needle fear underwent a craniotomy and biopsy of a frontal lesion while under general endotracheal anesthesia. During anesthesia induction, the patient was directed to hold the breathing tube tightly between her lips and breathe via her mouth into it with sevoflurane at 8% dial setting and 6 L/min of fresh gas flow. The snorkel approach was effectively used to induce anesthesia with better patient cooperation, and an intravenous cannula was inserted.
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How to cite this article: Vaithialingam B, Gopal S, Masapu D. Author Response. Indian J Crit Care Med 2024;28(1):87-88.
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Intra-arterial Melphalan injection is an emerging treatment for children with advanced retinoblastoma. The procedure, which is frequently performed under general endotracheal anesthesia, can be complicated by technical difficulty and cardiorespiratory instability, which the anesthesiologist should be aware of. We describe the anesthetic management and special concerns during super-selective intra-arterial Melphalan injection in an infant with advanced retinoblastoma.
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OBJECTIVES: Modified ECT is routinely conducted using face mask (FM) and bag ventilation technique. Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is a novel hands-free insufflation technique that provides oxygenation and prolongs apnoea time. There is limited literature comparing the two techniques. Primary objective of this study was to compare oxygen desaturation between THRIVE and FM techniques during ECT while secondary objective was to compare hemodynamics and complications. METHODS: Patients aged 18-50 years undergoing 3rd-5th ECT treatments were enrolled. First ECT was with FM technique followed by THRIVE (with LUBO collar) in the next ECT. Except for the oxygenation technique, the protocol for ECT administration was similar with both techniques. SpO2 values were recorded every minute for 10 min while hemodynamic parameters were measured at 2 min and 5 min following administration of electrical stimulus. Any drop in SpO2 below 92 % was considered as a desaturation event. RESULTS: A total of 201 patients underwent ECTs, one each with FM and THRIVE technique. Median age of patients was 28 years. There was no difference in SpO2 between the techniques (main effect P = 0.324, interaction P = 0.14). Only one patient had desaturation with THRIVE requiring intervention with FM. None of the patients had any airway complications in terms of nasal injury, hoarseness, or pneumothorax with THRIVE. CONCLUSION: THRIVE is a safe alternative option for hands-free oxygenation while administering ECT. However, considering patient safety, an anaesthesiologist competent in airway management must be readily available.
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How to cite this article: Vaithialingam B, Gopal S, Masapu D. "Locked-in State" Following Anterior Circulation Aneurysmal Subarachnoid Hemorrhage. Indian J Crit Care Med 2023;27(8):601-602.
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How to cite this article: Vaithialingam B, Arun BG. High-flow Tracheal Oxygenation with Airway Exchange Catheter: A Novel Approach. Indian J Crit Care Med 2023;27(6):456.
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A 24-year-old female presented to the emergency department with swelling of the forehead and oculus sinister. A soft, compressible glabellar swelling with proptosis of the oculus sinister was noted on clinical examination. Cerebral angiography revealed a left medial orbital wall arteriovenous fistula with feeders from the left internal maxillary artery, left superficial temporal artery, and left ophthalmic artery. During the cerebral angiography, a diffuse intracranial venous anomaly and left basal ganglia arteriovenous malformations were also noted. A diagnosis of Wyburn-Mason syndrome was made, and the patient underwent catheter embolization of the orbital arteriovenous fistula. After glue embolization of the left external carotid artery feeders, the patient experienced a 50% reduction in glabellar swelling in the immediate postoperative period. Glue embolization of the left ophthalmic artery feeder was planned after six months during the follow-up period.
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Takayasu arteritis (TA), also known as occlusive thromboaortopathy, is a type of chronic inflammatory arteritis that primarily affects large vessels. Compressive thoracic myelopathy is a rare and distinct manifestation of TA. We present the case of a 60-year-old woman who developed gradually progressive spastic paraplegia over one year. Magnetic resonance imaging revealed a well-defined extra-dual, intensely enhancing ventrodorsal lesion with severe spinal cord impingement. The aortogram revealed dilatation of the aortic arch (with narrowing of arch vessels) and descending aorta, as well as a right paravertebral soft tissue mass at the D4 level. Given the likelihood of TA, the patient underwent decompressive laminectomy and spinal fusion due to severe spinal cord compression. The biopsy of the dural-based lesion revealed an inflammatory granuloma, and the patient was treated postoperatively with oral prednisolone and mycophenolate mofetil. After six months of immunotherapy, there was excellent neurological recovery and near-total resolution of the lesion.
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The D-wave reflects the corticospinal fibre potentials and is frequently recorded intraoperatively for intramedullary spinal tumours to ensure maximum safe resection. A 38-year-old male had an intramedullary spinal cord tumour surgically removed while being monitored with D-wave from a single distal electrode technique. Total intravenous anaesthesia (TIVA) with propofol (without a muscle relaxant and with intermittent intravenous fentanyl boluses) was used for the maintenance of anaesthesia guided by processed electroencephalography (EEG) using a bispectral index (BIS®) monitor. Regular spike artefacts were observed in the EEG signal recorded by the BIS® monitor during the application of the single-pulse transcranial electrical stimulus and were used as a visual indicator of stimulus delivery. Finally, we propose a novel method of confirming stimulus delivery during D-wave recording based on stimulation artefacts in the EEG signal recorded by the BIS® monitor.
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Anestésicos Intravenosos , Propofol , Masculino , Humanos , Adulto , Artefactos , Electroencefalografía/métodos , Anestesia GeneralRESUMEN
Respiratory management is an important aspect of care in neuroanesthesia practice for neurosurgical patients. A wide variety of procedures are performed under sedation in the neurosurgical population, and maintaining oxygenation is of paramount importance during these procedures. The high-flow oxygen devices improve arterial oxygenation by providing higher inspiratory oxygen concentration and maintaining higher dynamic positive airway pressure. These devices have gained importance during the recent years with regard to enhancing patient safety. This narrative review focuses on the role of trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) and high-flow nasal oxygenation (HFNO) techniques in the neuroanesthesia practice and electroconvulsive therapy.