Amit Bodkhe

Abstract

Context: The subclavian vein is the preferred site for central venous catheter insertion because of its several advantages. Infraclavicular is the commonly used approach while supraclavicular is less popular approach for catheterizing the subclavian vein. Aims: The aim of the study was to compare supraclavicular and infraclavicular approach of subclavian vein catheterization in terms of number of attempts, success rate, access time for catheterization and to record the complications associated with the procedure. Materials and Methods: In this study, 120 patients of inclusion criteria were placed either in group supraclavicular (SC) or group infraclavicular (IC) for subclavian vein catheterization using modified Seldinger technique under general or local anaesthesia. Chi square test was used to compare success rate and independent T test for access time of catheterization between two groups. Results: First attempt success rate in group SC was 81.66% and in group IC was 66.66%. But overall success rate was 93.33% in group SC, whereas it was 90% in group IC. This was not statistically significant with p value of 0.5. Time taken for successful catheterization was 252.98 ± 76.27 seconds in group SC and 314.98 ± 121.28 seconds in group IC. This was statistically significant with p value of 0.001. Right brachiocephalic vein tear was the only complication in entire study which occurred in group IC. Conclusions: Subclavian vein catheterization via supraclavicular approach was a faster approach than infraclavicular, whereas both were comparable in terms of success rate. Keywords: Central venous catheter, Infraclavicular, Subclavian vein, Supraclavicular.

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Abstract

A 25- year old male patient, with subcarinal mass projecting into carina and lower tracheal lumen underwent carinal resection and reconstruction surgery. This was done through the laryngeal drop and bilateral thoracotomy approach. Intraoperative course was complicated by persistent hypoxia and arrhythmias. This report explores the various anaesthetic issues involved which were effectively managed. Keywords: Arrythmias, Carinal resection, Cross field ventilation, Intermittent apnea technique.

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Abstract

Surgery is one of the curative treatments for patients with tracheobronchial tumours. And endoscopic debridement is one of the palliative therapies for unresectable tumour. Respiratory distress is the commonest complication that can occur in both the procedures. We present the case of 25 year old patient of adenoid cystic carcinoma of lower trachea and left bronchus. He had respiratory distress after induction of anaesthesia which was managed successfully with one lung anaesthesia with single lumen endobronchial tube. It was inoperable tumour and after endobronchial debridement he had episode of tumour embolism to oppossite bronchus causing respiratory distress. This was detected immediately and managed successfully with flexible bronchoscopy. Keywords: Endobronchial tumour embolism, Tracheobronchial tumour, One lung anaesthesia, Respiratory distress.

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