Removal of an Epidural Catheter in a Patient Receiving Ticagrelor: A Case Report.

We report a case of a patient who had a coronary angioplasty and received heparin, clopidogrel, and ticagrelor on the evening of bilateral total knee arthroplasties performed under combined spinal epidural anesthesia. After a multidisciplinary meeting, the epidural catheter was removed 5 days after the dose of clopidogrel. With the catheter still in place, ticagrelor was continued to prevent stent thrombosis. Removing an epidural catheter in a patient on antiplatelet therapy must be done after a risk-benefit assessment, multidisciplinary collaboration, and stringent neurologic monitoring. The focus should be on prevention of a spinal hematoma, and rapid diagnosis and treatment to optimize the neurologic outcome.

An observational study: Effects of tenting of the abdominal wall on peak airway pressure in robotic radical prostatectomy surgery.

BACKGROUND: Robotic radical prostatectomy (RRP) is associated with various anesthetic challenges due to pneumoperitoneum and deep Trendelenburg position. Tenting of the abdominal wall done in RRP surgery causes decrease in peak airway pressure leading to better ventilation. Herein, we aimed to describe the effects of tenting of the abdominal wall on peak airway pressure in RRP surgery performed in deep Trendelenburg position. METHODS: One hundred patients admitted for RRP in Kokilaben Dhirubhai Ambani Hospital of American Society of Anesthesiologists 1 and 2 physical status were included in the study. After undergoing preanesthesia work-up, patients received general anesthesia. Peak airway pressures were recorded after induction of general anesthesia, after insufflation of CO2, after giving Trendelenburg position, and after tenting of the abdominal wall with robotic arms. RESULTS: Mean peak airway pressure recording after induction in supine position was 19.5 ± 2.3 cm of H2O, after insufflation of CO2 in supine position was 26.3 ± 2.6 cm of H2O, after giving steep head low was 34.1 ± 3.4 cm of H2O, and after tenting of the abdominal wall with robotic arms was 29.5 ± 2.5 cm of H2O. P value is highly statistically significant (P = 0.001). CONCLUSION: Tenting of the abdominal wall during RRP is beneficial as it decreases peak airway pressure and helps in better ventilation and thus reduces the ill effects of raised peak airway pressure and intra-abdominal pressures.

Successful anesthetic management of a large supraglottic cyst.

Excision of a huge-sized supraglottic mass nearly obstructing the airway passage is a real challenge to anesthesiologists. Upper airway obstruction due to neoplasm in supraglottic region is traditionally managed by preoperative tracheostomy. However, such a common procedure can potentially have an impact on long-term outcome.