The effect of combination of warm intravenous fluid infusion and forced air warming versus forced air warming alone on maternal temperature and shivering during cesarian delivery under spinal anesthesia.

Objective: Administration of warm intravenous (IV) fluid infusion and use of forced air warmers is the most easy and physiologically viable method for maintaining normothermia during surgery and postsurgical periods This study was conducted to assess the effect of combination of active warming (AW) methods namely warm IV fluid infusion and forced air warming versus forced air warming only (WA) on maternal temperature during elective C-delivery under spinal anesthesia. Materials and Methods: A total of 100 patients scheduled for elective c-section were grouped into those who received both warmed IV fluid infusion and forced air warmer (Combination of active warming WI= 50) and those who received only forced air warmer (WA = 50). Core body temperature and shivering incidence were recorded using a tympanic thermometer from prespinal till the end of surgery every 10 min and in postanesthesia care unit (PACU) at 0, 15, and 30 min. Results: Core temperature showed statistically significant difference in 15, 35, 45, and 55 min between air warmer and warm infusion groups and in PACU at 0, 15, and 30 min, it was statistically significant (P = 0.000) among WI group (mean temperature = 36.79°C) when compared to WA group (mean temperature = 35.96°C). There was a lower incidence of shivering in WI compared to WA group, which is statistically significant. Conclusion: Combination of warm Intravenous fluid infusion and Forced air warming is better than forced air warming alone. In maintaining near normal maternal core body temperature during elective cesarean section following spinal anesthesia. Combined warming method also reduces shivering incidence.

RésuméObjectif: L'administration d'une perfusion de liquide intraveineux chaud (IV) et l'utilisation de réchauffeurs à air forcé sont les plus faciles et les plus viables sur le plan physiologique méthode pour maintenir la normothermie pendant la chirurgie et les périodes post-chirurgicales Cette étude a été menée pour évaluer l'effet de la combinaison des méthodes de réchauffement actif (AW), à savoir la perfusion de liquide IV chaud et le réchauffement à air forcé par rapport au réchauffement à air forcé uniquement (WA) sur la mère la température pendant la livraison élective de C sous anesthésie rachidienne. Matériel et méthodes: Un total de 100 patients programmés pour un stage électif les césariennes ont été regroupées dans celles qui ont reçu à la fois une perfusion de liquide IV chauffée et un réchauffeur à air forcé (combinaison de réchauffement actif WI = 50) et ceux qui n'ont reçu qu'un réchauffeur d'air forcé (WA = 50). La température corporelle centrale et l'incidence des frissons ont été enregistrées en utilisant un thermomètre tympanique du préspinal jusqu'à la fin de la chirurgie toutes les 10 min et dans l'unité de soins postanesthésiques (PACU) à 0, 15 et 30 min. Résultats: La température centrale a montré une différence statistiquement significative en 15, 35, 45 et 55 min entre les groupes de réchauffement de l'air et de perfusion chaude et dans le PACU à 0, 15 et 30 min, il était statistiquement significatif (P = 0,000) dans le groupe WI (température moyenne = 36,79 ° C) en comparaison au groupe WA (température moyenne = 35,96 ° C). Il y avait une incidence plus faible de frissons dans WI par rapport au groupe WA, qui est statistiquement important. Conclusion: La combinaison de la perfusion de liquide intraveineux chaud et du réchauffement forcé de l'air est meilleure que le réchauffement forcé de l'air seul. Dans maintien d'une température corporelle maternelle près de la normale pendant la césarienne élective après anesthésie rachidienne. Réchauffement combiné La méthode réduit également l'incidence des frissons.

General Anesthesia Using Supraglottic Airway Device in a Myasthenic Patient Undergoing Reverse Shoulder Arthroplasty.

Myasthenia gravis (MG) is a neuromuscular disorder characterized by weakness and fatigability of skeletal muscles. The decrease in the number of acetylcholine receptors results in decreased efficiency of neuromuscular transmission. Although acetylcholine is released normally, it produces small end-plate potentials that fail to trigger muscle action potentials. Failure of transmission at many neuromuscular junctions results in weakness of muscle contraction. This also makes them susceptible to neuromuscular blocking agents which pose a challenge to the anesthesiologist. Here, we report a case of a patient who was a known case of MG posted for reverse shoulder arthroplasty, who was managed using a supraglottic airway device and spontaneous respiration.

A Rare Cause of Postoperative Bleeding from A Lytic Lesion of Calcaneum.

INTRODUCTION: Post-operative excessive bleeding can be due to various causes, which may platelet deficiency, both quantitative and qualitative, vascular disorder, clotting factor defects and excessive fibrinolysis. Rarely can be due to some undiagnosed malignant tumours. Angiosarcoma of bone is an exceedingly rare primary bone malignancy. We report an interesting and rare case of an intraosseous angiosarcoma that presented as an excessive postoperative bleeding with diagnostic dilemma. CASE REPORT: A twenty eight year old gentleman admitted to our hospital with history of continuous bleeding from surgical site over left heel since three months. About six months ago he was evaluated elsewhere for a painful progressive lesion in the left calcaneum. Following which he underwent curettage of lesion with bone grafting. One month after this he was re-operated for recurrence with curettage with bone cementing. Curetted material on both occasions was reported as aneurysmal bone cyst. One month following the second surgery, surgical scar over the outer aspect of left heel opened out and started to bleed continuously. X rays and MRI done before surgical treatment were suggestive of aneurysmal bone cyst Investigations for clotting and bleeding disorders were normal. The granulation tissue from the floor of the cavity was curetted and sent for histopathology, which was reported as angiosarcoma. CONCLUSION: Intraosseous angiosarcoma is a rare primary bone tumour. The diagnosis is often delayed because of the non-specific clinical presentation and radiological features. Clinicopathological correlation is very important to differentiate aneurysmal bone cyst from the aggressive type of vascular malignancies. The clinical course of disease is aggressive, as demonstrated by this current case. The initial biopsies done twice at curettage were not diagnostic and suggested the presence of a benign aneurysmal bone cyst. Due to the excessive postoperative bleeding, repeat biopsy performed which diagnosed angiosarcoma.