Preanesthetic Evaluation Research Articles

To Compare the Efficacy of Betamethasone Gel and Lignocaine Gel Applied over Endotracheal Tube to Reduce Post Operative Sore Throat and Cough

Background: Post-operative sore throat, cough and hoarseness of the voice are often common, uncomfortable sequelae after tracheal intubation with inflammation being the most common pathogenesis. Post operative sore throat and cough has a multifactorial aetiology that includes patient-related factors such as age, sex, and smoking, as well as intubation factors such as technique, duration, tube size, intracuff pressure, cuff design, trauma to the pharyngolaryngeal mucosa and various factors.
 Objectives: To compare the incidence of post operative sore throat, cough after endotracheal tube intubation when applying betamethasone gel and lignocaine jelly.
 Materials and Methods: At Saveetha Medical College and Hospital in Thandalam, Chennai, a prospective controlled double blinded study was done among patients who were scheduled for elective procedures under general anaesthesia with orotracheal intubation. The study comprised 60 patients who met the study's inclusion and exclusion criteria. The 60 patients were divided into two study groups each enrolled with 30 patients. Before the study could begin, approval from the institutional research board was required. Before the study began, an informed, written consent was obtained. The method used was Qualitative observational randomised double blind study by using a computer-generated random number table and the sealed envelope approach, patients were assigned to one of two equal groups.
 Following a pre-anaesthetic evaluation, 60 patients of either sex, aged 18 to 60 years, with an ASA physical status of I or II, who were undergoing elective surgery (likely to last up to 240 minutes) under general anaesthesia with orotracheal intubation and met the above inclusion criteria were included in the study. The differences between the study groups were analysed by chi square test and the “p” value used as a cut off for estimating statistical significance between groups is 0.05.
 Results: The incidence and severity of post operative sore throat and cough after endotracheal intubation during 6 and 24 hours was found to be statistically significantly in patients in whom betamethasone was used. The results are significant at p<0.05.
 At 6 hours the incidence of post operative sore throat for betamethasone and lignocaine was 12% and 30% respectively. At 24 hours the incidence of post operative sore throat for betamethasone and lignocaine was 9.36% and 25.2% respectively.
 At 6 hours the incidence of post operative cough for betamethasone and lignocaine was 8.4% and 24%.At 24 hours the incidence of post operative cough for betamethasone and lignocaine was 7.2% and 21.6% respectively.
 Conclusion: The use of 0.05 percent betamethasone gel to lubricate the endotracheal tube before intubation helps to reduce the time it takes for symptoms to resolve.

Anesthesia in small animals during surgical procedures: Review

This review aims to provide information for the veterinarian to guarantee a safer anesthetic period for dogs and cats. For this part, the main points of the construction of an anesthetic protocol in surgical procedures for small animals, based on history and previous exams, as well as the preparation of equipment and accessories used for anesthesia and monitoring will be pointed out. Several aspects will be considered for success in anesthesia, such as: communication with the tutor in which the type of anesthetic procedure and the risk factors specific to the animal's tutor are presented; pre-anesthetic evaluation to evaluate the patient and his possible physiological changes; premedications and sedative and anxiolytic drugs used in the anesthetic period; preparation of anesthetic equipment ensuring that all selected are connected and connected to the source; anesthetic induction achieved effectively and efficiently by intravenous administration of fast-acting drugs; anesthetic maintenance by a combination of injectable and inhalant drugs or separately; and the patient's anesthetic recovery, when he continued to monitor the patient's physiological parameters until complete recovery. Therefore, considering the external aspects, the complexity of the anesthetic procedure and the need to include actions from the moment the animal is at home until anesthetic recovery is evident.

Telemedicine for preanesthesia evaluation: review of current literature and recommendations for future implementation.

The in-person preanesthesia visit serves multiple purposes including identification and optimization of comorbid conditions as well as patient education. However, it imposes a significant burden on patients and healthcare providers. In this review, we define the scope of telemedicine and present the most up-to-date literature supporting its role for the preanesthesia evaluation. The opportunities and challenges are discussed and approaches to implementation of telemedicine in preanesthesia care are offered. Finally, the future of telemedicine as it pertains to preanesthesia care is examined. Although telemedicine for preanesthesia practice was proposed almost two decades ago, the COVID-19 pandemic has accelerated its implementation. The potential benefits of telemedicine include improved patient satisfaction as well as the ability to provide cost-effective specialty services while reducing the burden on healthcare providers. Limitations to telemedicine include lack of technology, training, regulatory barriers, and an inability to perform a physical exam. Telemedicine will continue to expand and its application to the preanesthesia evaluation is a clear example of how technology will revolutionize anesthesia practice. In order for telemedicine to continue to expand in the postpandemic period, steps must be taken to ensure that healthcare facilities and providers keep up with the times.

Laparoscopic cholecystectomy under spinal anesthesia with intravenous sedation, its feasibility, safety, cost effectiveness and outcome: A prospective observational study

Introduction: Gallstones disease is one of the most common problems seen in surgical OPD requiring laparoscopic cholecystectomy in symptomatic patients. Routinely all laparoscopic surgeries are performed safely under general anesthesia, and practice of using spinal anesthesia is very less as most of patients experience shoulder discomfort. To alleviate the shoulder discomfort use of intravenous sedation can be implemented. Aims and Objectives: To perform Laparoscopic cholecystectomy safely under spinal anesthesia with i.v sedation for symptomatic gallstones diseases, and to assess the analgesic effect of the procedure in the early post-operative period, Safe completion of surgery and operative time and inoperative events. Materials and Methodology: It is a prospective observational study where in 50 patients who presented with biliary colic meeting the inclusion criteria were enrolled. All patients underwent hematological and biochemical investigations, appropriate investigation (LFT, USG, and chest x ray, CT scan / MRCP if needed) were performed based on clinical suspicion. All patients underwent pre-anesthetic evaluation and patients belonging to ASA grade 1 and 2 were taken up for surgery under standard lumbar spinal anesthesia technique with additional intravenous ketamine as sedation. Results: Spinal anesthesia with i.v sedation was adequate for surgery in all the 50 patients (100%) with none of patients requiring to convert to general anesthesia (100%) Intraoperatively two out of fifty (4%) patients experienced right shoulder pain. Two patients (4%) were given Midazolam for anxiety and one (2%) was given Ephedrine for hypo tension. One patient (2%) had desaturation for which high oxygen was given. Operative difficulty scores were minimal and none of them requiring to convert for open cholecystectomy (100%). Post operatively pain scores were minimal and four patients demanded opioid (20%). One patient (2%) required anti-emetic for vomiting and no patient suffered headache (0%) and urinary retention (0%). 34 patients (68%) were discharged within 24 hours of surgery and patient satisfaction scores were very good. Conclusion: This study suggest that laparoscopic cholecystectomy can be performed safely under spinal anesthesia with intravenous sedation in ASA grade 1&2 patients providing good analgesia and muscle relaxation in intra operative period and post-operative analgesia and helps in early recovery.

Recovery outcome of Thiopentone vs. Propofol as anaesthetic agent in pediatric patients of 2-10 years age group undergoing magnetic resonance imaging (MRI)

Background: Children between 2-10 years age group who undergo magnetic resonance imaging (MRI) requires sedation/ general anaesthesia for good quality images, as immobility is very essential. Providing sedation/GA in an MRI suite is quite different than in operation theatre. This study is undertaken to compare two drugs Propofol and Thiopentone as anaesthetic agents to provide sedation and immobilization during MRI and to compare their recovery time and recovery characteristics in children between age 2-10 years undergoing MRI. Aims and objectives: To compare the recovery outcome of Thiopentone and Propofol as an anaesthetic agent in children undergoing MRI of age 2-10 yrs. Objectives: to assess the recovery by Glasgow coma scale (GCS) immediately after the procedure, at the end of 15mins, 30mins and 1hour. Methodology: This Quasi Experimental study was conducted on 40 children who were undergoing elective MRI for various reasons, were divided into two groups, using sealed envelope method. Group T (Thiopentone): n=20 Group P (Propofol): n=20, A detailed preanaesthetic evaluation was done. Instructed NPO guidelines were followed and premedication with Triclofos 50mg/kg and Atropine 0.02mg/kg was given 60 minutes before the scheduled time. Patients in the T group were induced with inj. Thiopentone 4mg/kg, and maintained with 0.5-1mg/kg/min. patients in group P were induced with inj. Propofol 1mg/kg and maintained with 100-150mcg/kg/min. Study begins at the end of the procedure, where parameters like response to oral commands, and GCS assesment immediately, at 15min, 30 min and at the end of 1 hour are noted. Results: GCS assessment in Propofol group was better statistically as the p value was 0.002, 0.013, 0.00 and 0.00 at various time interval. Conclusion: The Propofol group had faster and complete recovery, when compared to Thiopentone group.

Suspicion of tooth aspiration during general anaesthesia in a paediatric patient – a case report

Foreign body aspiration or suspicion of it is a serious medical condition, which can cause life-threatening complications, especially in paediatric population. More than 80% of foreign body aspirations occur in children under three years of age. Children are a particularly vulnerable group due to specifi c anatomy of the airway. Symptoms of aspiration vary from suff ocation, coughing to complete absence of symptoms, which is why a diff erential diagnosis between aspiration and ingestion is sometimes very diffi cult. A six-year-old boy was admitted for elective surgery to correct vertical strabismus. At the pre-anaesthesia evaluation, the child was classifi ed as an ASA II patient, due to frequent laryngitis and bronchitis. The Mallampati score was 1 with no wobbly teeth recorded. After anaesthesia induction, the airway was secured with a laryngeal masksize 3.0 without complications. Upon awakening of the patient and removal of the laryngeal mask, blood was observed in the lodge of the lower left incisor and a lack thereof. The patient was without signs of respiratory distress. An emergency chest X-ray ruled out a foreign body in the airway, and subsequent X-rays of the abdomen revealed the presence of teeth in the projection of the stomach. The child was discharged to home care without complications. The clinical picture of foreign body aspiration under anaesthesia may be atypical and asymptomatic. Therefore, even the slightest suspicion of aspiration, especially in anaesthesia procedures, should be ruled out or confi rmed. Complications are most often the result of late-recognized aspiration.

A Comparative Study to Evaluate the Efficacy of Virtual Versus Direct Airway Assessment in the Preoperative Period in Patients Presenting for Neurosurgery: A Quest for Safer Preoperative Practice in Neuroanesthesia in the Backdrop of the COVID-19 Pandemic!

Objectives Neurosurgical patients with cervical spine pathologies, craniofacial and craniovertebral junction anomalies, recurrent cervical spine, and posterior fossa surgeries frequently present with an airway that is anticipated to be difficult. Although the routine physical evaluation is nonaerosol-generating, Mallampati scoring, mouth opening, and assessment of lower cranial nerve function could potentially generate aerosols, imposing a greater risk of acquiring severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection. Moreover, airway evaluation requires the patient to remove the mask, thereby posing a greater risk to the assessing anesthesiologist. Thus, we designed this study to evaluate the efficacy of virtual airway assessment (VAA) done via telemedicine in comparison to direct airway assessment (DAA), and assess the feasibility of VAA as a part of the preanesthetic evaluation (PAE) of patients presenting for neurosurgery in the backdrop of the COVID-19 pandemic. Materials and Methods A total of 55 patients presenting for elective neurosurgical procedures were recruited in this prospective, observational study. The preoperative assessment of the airway was first done by a remote anesthetist via an encrypted video call, using a smartphone which served the purpose of telemedicine equipment, followed by a direct assessment by the attending anesthetist. The following parameters were assessed: mouth opening (MO), presence of any anomalies of tongue and palate, Mallampati classification (MPC) grading, thyromental distance (TMD), upper lip bite test (ULBT), neck movements, and Look-Evaluate-Mallampati-Obstruction-Neck mobility (LEMON) scoring system. Statistical Analysis Demographic parameters were expressed as mean ± SD. Agreement between the values obtained by VAA and DAA parameters were analyzed with the Kappa test. Results We observed a “perfect agreement” between the DAA and VAA with regard to MO. Assessment of ULBT, neck movements, and the LEMON score had an overall “almost perfect agreement” between the DAA and VAA. We also observed a “substantial agreement” between VAA and DAA during the assessment of MPC grading and TMD. Conclusion Our study shows that PAE and VAA via telemedicine can reliably be used as an alternative to direct physical preanesthetic consultation in the COVID-19 scenario. This could reduce unnecessary exposure of anesthesiologists to potential asymptomatic COVID-positive patients, thereby protecting the available skilled workforce, without any significant compromise to patient care.

“EFFECT OF EPIDURAL VOLUME ON SPINALANAESTHESIA IN PATIENTS UNDERGOING GYNAECOLOGICAL SURGERY”

BACKGROUND: The epidural volume extension (EVE) technique is a modication of Combined Spinal Epidural Anesthesia (CSEA) in which the level of sensory analgesia obtained via subarachnoid block (SAB) is increased by a small volume of saline or local anaesthetic (LA) administered into epidural space through the epidural catheter. OBJECTIVE OFTHE STUDY: To study the effect of epidural volume on the time of onset of sensory blockade and the maximum height of the sensory block achieved in spinal anesthesia. MATERIALS AND METHODS: A prospective randomized study of 100 patients belonging to ASA physical status I & II. A pre-anesthetic evaluation and clinical examination with baseline investigations like CBC, urine routine, CXR, blood sugars, RFTand ECG were done. Patients were randomly allocated into 2 groups of 50 each. Group S(control) received 3 ml of 0.5% Bupivacaine (H) injection intrathecally. Group E(study) received 10 ml of Normal Saline epidurally immediately after spinal anesthesia with 3 ml of 0.5% Bupivacaine (H). The time of Onset of sensory blockade, maximum height of sensory block, hemodynamic status and adverse effects if any were compared in both the groups. RESULTS: The time of onset of sensory block was signicantly lower in Group E (2.08 ±0.77) than Group S (3.22±0.84). The maximum height of sensory block attained by Group E was T1 (18%) while that in Group S was T2 (6%). Maximum no of patients (36%) in group E attained a sensory level of T2 whereas in Group S, maximum no. of patients (40%) attained a sensory height of T6. Hemodynamic changes were not much different in patients of both the groups. The side effect was less in Group S as compared to Group E. CONCLUSION: We concluded that EVE of 10 ml of 0.9% saline with 3 ml of intrathecal 0.5% bupivacaine(H) fastens the onset and increases the height of sensory block with minimal hemodynamic changes.

Pre anesthetic assessment: study on the influence of preoperative approach on patient satisfaction during the covid-19 pandemic

Anesthesiology provides absence of or relief from pain and other sensations to patients who need to undergo medical procedures. Those who specialize in this area have been expanding their fields of action not only intraoperatively, but also pre- and postoperatively. Recently, going to pre-anesthetic office was implemented as mandatory for anyone who undergo surgery. However, the COVID-19 pandemic made attending to such meetings difficult, so many of them were done online. This research evaluated the degree of satisfaction with anesthesia office of a sample of the population who underwent surgical procedures during the aforementioned pandemic, verifying the importance of the anesthesiologist and the trust of the community after their contact with this professional, focusing on their opinion regarding the elucidation of doubts and reduction of anxiety symptoms. Pre-anesthetic evaluation has been shown to reduce anxiety and clear doubts about anesthetics procedures. Moreover, this prior contact was considered relevant by the patients.

Preoperative unexpected prolongation of the activated partial thromboplastin time and prothrombin time in adults. Do we need to pursue abnormal results? A retrospective analysis

BackgroundPreoperative coagulation screening tests are still performed often to assess bleeding risk; however, the effectiveness of this practice is a matter of debate and no longer recommended by some professional societies. We aimed to assess the management of unexpected prolonged activated partial thromboplastin time (APTT) and/or prothrombin time (PT) prior to elective surgery, and the perioperative hemorrhagic outcomes. MethodsThis was a retrospective cohort study conducted at a tertiary care hospital in Madrid, Spain. Patients who attended a preoperative anesthesia consultation between January 2013 and December 2018 were selected. 45,223 patients were screened for eligibility. After excluding children and patients with a preexisting cause for abnormal coagulation or who were receiving anticoagulation therapy, 722 adults with prolonged APTT and/or prolonged PT in coagulation screening tests were included in the study. Patients were grouped according to whether they were referred for a Hematology consultation or were scheduled to undergo surgery without further investigation. The primary endpoint was to compare perioperative bleeding complications. Results271 patients (38.5%, 95% CI 34.9 to 65.1) were referred to a Hematologist while 433 (61.5%, 95% CI 57.9 to 65.1) did not undergo further investigation. In 95% of the patients referred for a Hematology consultation, no significant hemostatic disorders were detected. No difference in perioperative hemorrhagic outcomes were found between the two groups. Additional studies were associated with a follow up pre-anesthetic evaluation median delay of 36,5 days (IQR 28 to 49) and a total referral cost of 45 596 euros ($ 54,100). ConclusionsFurther investigations of APTT and PT prolongations did not have any benefit in terms of hemorrhagic complications, and were associated with a significant preoperative delay and increase of healthcare costs. We recommend the more beneficial and cost-effective approach of selective preoperative coagulation testing based on bleeding history.

The correlation between the STOP-Bang score and oxygen saturation during spinal anesthesia with dexmedetomidine sedation.

BackgroundThe STOP-Bang questionnaire is a simple screening tool with high sensitivity for the detection of severe obstructive sleep apnea. Predicting airway obstruction would allow the safe management of sedative patients to prevent intraoperative hypoxia. This study was designed to check the correlation between the STOP-Bang score and oxygen saturation (SpO2) during sedation and confirm the availability of the STOP-Bang questionnaire as a preoperative exam for predicting the incidence of hypoxia in sedative patient management.MethodsThis study included 56 patients who received spinal anesthesia. The pre-anesthesia evaluation was conducted using the STOP-Bang questionnaire. The patients were under spinal anesthesia with an average block level of T10. Dexmedetomidine was infused with a loading dose of 1 μg/kg over 10 min and a maintenance dose of 0.5 μg/kg/h until the end of the procedure. The SpO2 of the patients was recorded every 5 min.ResultsThe STOP-Bang score was negatively correlated with the lowest SpO2 (coefficient = –0.774, 95% confidence interval [CI]: –0.855 to –0.649, standard error [SE] = 0.054, P < 0.001). The item of “observed apnea” was the most correlated one with hypoxic events (odds ratio = 6.00, 95% CI: 1.086 to 33.145).ConclusionsThe STOP-Bang score was significantly correlated with the lowest SpO2 during spinal anesthesia, which enabled the prediction of meaningful hypoxia before it occurred in the sedated patients.

Perioperative management of post-COVID-19 surgical patients: Indian Society of Anaesthesiologists (ISA National) Advisory and Position Statement.

Perioperative management of post-COVID-19 surgical patients: Indian Society of Anaesthesiologists (ISA National) Advisory and Position Statement.

Effect of 1 puff of sublingual nitroglycerin spray versus 1 puff of normal saline spray in attenuating pressor response to extubation

Ideal agent to attenuate hemodynamic response to extubation should be readily available, easy to administer, cost effective with fast onset of action and peak with minimal side effects. Nitroglycerin is one of the most widely used drug to control intra-operative rise in blood pressure. Nitroglycerin is potent vasodilator, predominantly acting on venules than arterioles by generating nitric oxide (NO) in vascular smooth muscle. A thorough pre-anaesthetic evaluation was done on day before surgery. Detailed medical history was elicited and detailed physical examination was carried out. Patients were kept nil per orally for 8 hours prior to surgery. Preoperatively investigations like CBC, RBS and Sr. Creatinine were done. ECG and CXR were done if patient was more than 40 years of age. In our study patient received 1 puff (0.4mg) which resulted in a small although insignificant increase in BP till 3 minutes. It may be possible to attenuate this small increase in BP by using higher dose of NTG spray instead of 0.4mg and requires further evaluation. It was observed that there was tachycardia as Injection Glycopyrrolate was given just before intervention since, both the groups received the same drug it will not act as bias.

The aftermath of COVID-19 pandemic: Rhino-orbital mucormycosis.

The aftermath of COVID-19 pandemic: Rhino-orbital mucormycosis.

Information technology-based joint preoperative assessment, risk stratification and its impact on patient management, perioperative outcome, and cost.

Background: Despite negative recommendations, routine preoperative testing practice is nearly universal. Our aim is to bring the healthcare providers on one platform by using information-technology based preanaesthetic assessment and evaluate the routine preoperative testing’s impact on patient outcome and cost. Methods: A prospective, non-randomised study was conducted in a teaching hospital during January 2019-August 2020. A locally developed software and cloud-computing were used as a tool to modify preanaesthesia evaluation. The number of investigations ordered, time taken, cost incurred, were compared with the routine practice. Further data were matched as per surgical invasiveness and the patient's physical status. Appropriate tests compared intergroup differences and p-value <0.05 was considered significant. Results: Data from 114 patients (58 in routine and 56 in patient and surgery specific) were analysed. Patient and surgery specific investigation led to a reduction in the investigations by 80-90%, hospital visit by 50%, and the total cost by 80%, without increasing the day of surgery cancellation or complications. Conclusion: Information technology-based joint preoperative assessment and risk stratification are feasible through locally developed software with minimal cost. It helps in applying patient and surgery specific investigation, reducing the number of tests, hospital visit, and cost, without adversely affecting the perioperative outcome. The application of the modified method will help in cost-effective, yet quality and safe perioperative healthcare delivery. It will also benefit the public from both service and economic perspective.

The inductor role of cardiac consultation in the pre-anesthetic evaluation of asymptomatic patients submitted to non-cardiac minor and intermediate-risk surgery: a cross-sectional study

IntroductionAsymptomatic patients with moderate functional capacity do not require Coronary Artery Disease (CAD) workup in the preoperative period of non-cardiac surgeries, especially when scheduled for minor and intermediate-risk surgeries. The workup is inappropriate because it promotes over diagnosing and pointless treatments. Moreover, those patients usually undergo cardiology assessment, in addition to pre-anesthetic evaluation. ObjectiveInvestigate the role of cardiology consultation as mediator in inappropriate assessment of CAD for preoperative of non-cardiac surgeries. MethodRetrospective study performed in a private anesthesia service using medical charts of asymptomatic patients with a history of controlled systemic disease and moderate functional capacity, submitted to pre-anesthetic consultation for minor and intermediate risk surgeries. Cardiology consultations were identified by the presence of a consultation report by a cardiologist. CAD workup was defined as undergoing cardiac stress tests. ResultsWe included 390 medical charts of patients with mean age of 48.6 ± 15.4 years, 67% women and 69% intermediate risk surgeries. CAD workup was infrequent and performed in 3.9% of patients. Besides, pre-anesthetic evaluation, 93 (24%) patients had a cardiology consultation. Among those patients, 15.1% were submitted to CAD workup, compared to 0.34% of patients without cardiology assessment (p < 0.001; RR = 4.4; 95% CI: 3.5–5.6). ConclusionsInappropriate testing for CAD investigation is infrequent for asymptomatic individuals submitted to minor and intermediate risk surgeries. However, cardiology consultation increases substantially the likelihood of a patient undergoing CAD workup, suggesting that, unlike the anesthesiologist, the cardiologist is a major mediator of this kind of management.

Cardiac Arrest and Complications after Spinal Anesthesia: The Perioperative and Anesthetic Adverse Event in Thailand (PAAd Thai) Incident Report Study

Background: Spinal anesthesia is one of most common anesthetic techniques in Thailand. The Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study was a multicentered project among 22 hospitals across the country to investigate the incidence of anesthesia related complications. Objective: To study the incidences of cardiac arrest and complication after spinal anesthesia including the contributing factors and suggested corrective strategies. Materials and Methods: This prospective descriptive study of the incident reports that occurred regarding spinal anesthesia collected from 22 participating hospital in the data collection between January and December of 2015 was completed. Three senior anesthesiologists reviewed the data and descriptive statistics were used. Results: Among 62,120 spinal anesthesia, there were 127 incidents (5.8%) among 2,206 incident reports related to anesthesia. There were seven cases of intraoperative cardiac arrest with an incidence of 1.13:10,000 spinal anesthesia (95% CI 0.55 to 2.33). Other complications were bradycardia with less than 40 beats per minute (50.4%), anaphylaxis or anaphylactoid reaction or drug allergy (14.2%), drug error (8.4%), coma or CVA or convulsion (3.9%), and suspected pulmonary embolism (3.9%). Adverse events occurred frequently with specialties or surgeries of orthopedics (44.1%), cesarean delivery (17.3%), urosurgery (17.3%), general surgery (14.2%), and gynecological surgery (4.7%), respectively. Conclusion: Contributing factors were inexperience, inappropriate decision making, haste, and inappropriate pre-anesthetic evaluation or preparation while factors minimizing incidents were vigilance, having experience, and experienced assistants. Suggested corrective strategies were quality assurance activity, guidelines especially monitoring, improvement of supervision, and additional training. Keywords: Spinal anesthesia, Adverse events, Incidents, Complications, Neuraxial anesthesia, Cardiac arrest

Anaesthetic Managemetnt of Surgical Resecton of A Giant Mediastinal Mass – A Case Report

Giant mediastinal mass tumors have been associated with perioperative respiratory and circulatory life- threatening complications during induction of general anaesthesia and initiation of positive pressure ventilation leading to sudden cardiac arrest known as MMS, ‘Mediastinal mass syndrome’ (4, 5,6). A detailed meticulous preanaesthetic evaluation and a well thought out anaesthetic plan can avoid life-threatening events during management of these patients. We report a successful anaesthetic management of a 12 yrs old pediatric patient with a left sided giant mediastinal germ cell tumor, posted for complete surgical resection. We followed the guiding principles for anaesthetic management of such cases, maintaining propped up position, avoiding muscle relaxants, maintaining spontaneous breathing, keeping cardiac team and perfusion team ready to cannulate and institute CPB in case of sudden cardiorespiratory collapse, adapting to low volume ventilation and titrated and step wise induction of anaesthesia.

A Short Course on the Teachings of Paul Barash.

A Short Course on the Teachings of Paul Barash.

Achondroplasia and emergency caesarean section: A case report

Achondroplasia is the commonest variety of rhizomelic dwarfism, which results from abnormal cartilage formation at epiphyseal growth plates. The peculiar facial features, bony deformities and systemic abnormalities often pose a difficulty in administration of anesthesia, particularly in the parturients. There are very few reported cases of spinal anesthesia in achondroplastic parturients, because of its feared high risks. We reported, two cases of achondroplastic parturients with short stature, planned for emergency lower segment caesarean section (LSCS), in view of cephalo-pelvic disproportion under spinal anesthesia. We discussed the anesthetic issues to achondroplastic parturients and finally did under spinal anesthesia. Besides, a myriad of problems encountered in these patients warrant a careful pre-anesthetic evaluation to warrant patients' safety and affirmative procedure outcomes.