Alka Chandra

Abstract

We present a female patient posted for fixation of fracture femur under subarachnoid block. After spinal anaesthesia she developed hypotension and cardiac arrest. Subarachnoid haemorrhage was diagnosed by CT scan of head when she did not regain the consciousness. Inspite of all the efforts she had a fatal outcome. We discuss the probable causes of subarachnoid haemorrhage after a simple procedure like spinal anaesthesia with an unusual presentation.   Keywords: Subarachnoid haemorrhage, Spinal puncture, Aneurysms

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Abstract

Introduction: Failure to secure the airway can lead to adverse cardiopulmonary events, brain damage or even anaesthetic death. The advent of various optical or video laryngoscopes have brought about a revolution in airway management. Truview PCDTM laryngoscope is a recently introduced device with a unique blade and prismatic lens which without external manipulation makes visualization of laryngeal inlet much easier. We have therefore compared glottic visualization haemodynamic response and ease of intubation between Truview PCDTM, McCoy and Macintosh laryngoscope blades. Material and Methods: Patients were randomly allocated into three groups of 40 each. Group I-Truview PCD TM laryngoscope, group II- McCoy laryngoscope and group III- Macintosh laryngoscope group. After induction patients were intubated with appropriate blade according to the group allocated. Visualization of laryngeal inlet was graded using Modified Cormack and lehane. Ease of intubation was also graded and hemodynamic parameters were noted on following occasions. Baseline (T1), before induction (T2), after induction (T3), immediately after intubation (T4), 1 min, 3 min and 5 min after intubation (T5,T6 and T7 respectively). Result: Quantitative variables were co-related using ANOVA/Kruskal Wallis test between the three groups and post hoc comparison was performed by independent T test/ Mann-Whitney test (when the data sets were not normally distributed) between the two groups. Qualitative variables were correlated using Chi-square test/Fisher’s exact test. The data was entered in MS EXCEL spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0 (Chicago, USA). A P-value of There was a difference in visualization of glottis which was statistically significant between the three groups (P Conclusion: Truview PCD TM laryngoscope blade can be used in difficult airway situation to visualize glottis. The time taken to intubate is longer and failure rate is slightly higher which can however be reduced by proper training, experience and increased hand eye co-ordination. Keywords: Laryngoscopes, Airway management, Anaesthesia, Arterial pressure.

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Abstract

Osteopetrosis (Marble Bone Disease) refers to a group of disorders of skeleton characterized by increased bone density on radiographs. We should be aware of this entity as due to difficult airway and sclerotic spine anesthetizing these patients may be a challenging task. Proper anesthesia work up and adequate preparedness can lead to successful management thus preventing the morbidity. We present here a case of osteopetrosis in which the diagnosis was missed in the pre-operative period. Keywords: Anesthesia, Osteopetrosis, Musculoskeletal system.

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