Ninad Chodankar

Abstract

Over the past few decades, oncosurgical procedures are increasing in number, require considerable expertise and training for anaesthetising such patients. Aortic Stenosis itself poses great challenge, causes significant increase in morbidity and mortality in the perioperative period. Head, neck oncosurgical procedures with difficult airway requiring awake fiberoptic intubation in such patients adds to the challenge. We describe once such case of previously operated Carcinoma of oral cavity with new growth involving mandible for excision of tumour with neck dissection and mandibular reconstruction with a free Fibula flap. This patient now presented with anticipated difficult airway with restricted mouth opening and a recent diagnosis of severe Aortic stenosis with mean gradient across aortic valve of 52mmHg and valve area 0.8 cm2. Such patient requires multidisciplinary team approach by cardiologist, anaesthesiologist, surgeon and intensivist to prevent perioperative morbidity and facilitate early recovery.   Keywords: Difficult, Airway, Aevere, Aortic, Stenosis, Oncosurgery.

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Abstract

Middle aortic syndrome is a rare congenital disease which involves segmental or diffuse narrowing of the abdominal and/or distal descending thoracic aorta. It may remain largely undetected in childhood and can present itself as gestational hypertension during pregnancy. Upper extremity hypertension is difficult to control during pregnancy. Excessive blood pressure lowering may result in hypotension distal to the obstruction and uterine hypoperfusion.It offers considerable challenge to Anaesthesiologist regarding choice of anaesthesia – Regional verses General Anaesthesia. Both having its own advantages and disadvantages in such patient.We describe a 29 years, primigravida with Middle aortic syndrome, diagnosed during first trimester. Patient was admitted with severe hypertension in upper extremity at 39 weeks. Caesarean delivery was carried out under General Anaesthesia. During perioperative period, Intravenous Nitroglycerine and Labetalol were used to maintain hemodynamic stability. Patient was shifted to ICU on ventilator. She had uneventful course in ICU and recovery was good.Pregnant Patient with uncorrected Middle aortic syndrome for Caesarean Section require suitable anaesthesia technique along with good blood pressure management leading to early recovery and reduction in complications.   Keywords: Middle, Aortic, Syndrome, Coarctation, Aorta, Caesarean, Section.

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Abstract

Percutaneous Coronary Intervention (PCI) is an accepted modality of treatment in patient with coronary artery disease. Coronary artery perforation is very rare but serious complication that can occur while performing PCI. We describe two cases of coronary perforation while performing PCI. In first case, coronary perforation could not be sealed with coronary stent and required emergency surgery. And in second case, we were able to seal the coronary perforation with stent and avoid surgery. Coronary artery perforation requires team approach by cardiologist, anaesthesiologist and surgeon for early recovery and good outcome. Keywords: Coronary, Intervention, Perforation, Percutaneous.

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