Kriti Nagar

Abstract

Fraser syndrome is a rare autosomal recessive genetic disorder characterized by cryptophthalmos, syndactyly, genital malformations, renal abnormalities, musculoskeletal abnormalities and mental retardation. We present a rare case of one such adolescent girl who presented with hematometra and was operated for the same. We hereby discuss the anaesthetic management of this patient with emphasis on points that may prevent any inadvertent complications due to associated co-morbidities.   Keywords: Fraser syndrome, Spinal anaesthesia, Vaginoplasty, Autosomal recessive, Cryptophthalmos, Paediatric anesthesia, Difficult airway

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Abstract

Cardiac patient for non cardiac surgery has since forever been a topic of interest for the anaesthesiologist. Few cases have only been reported with their own suitable line of management, however the simultaneous use of combined epidural spinal anaesthesia and Dexmedetomidine, an ?2 agonist has been studied by only a handful. Use of epidural for incremental doses of local anaesthetic for allaying the postoperative pain and thereby reducing the occurrence of ischemic events is also being described. Keywords: Ischaemic Heart Disease, Epidural Anaesthesia, Ejection Fraction, Dexmedetomidine.

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Abstract

Background: Brachial plexus block is widely used as an efficient and cost effective alternative to general anesthesia for upper limb surgeries. A variety of adjuvants to local anesthetics have been used and compared, however, drugs which prolong the duration of anaesthesia and analgesia are being constantly studied for patient satisfaction and cost effectiveness. Materials and Methods: Prospective, Interventional, Randomised study was conducted over 105 patients scheduled for elective upper limb surgeries under brachial plexus block, who were randomly allocated into three groups of 35 patients each. Group I- Bupivacaine with Tramadol, Group II- Bupivacaine with Dexamethasone and Group III- Bupivacaine alone. The time of onset and duration of sensory and motor block was noted. Hemodynamic variables were measured from baseline until the use of first rescue analgesic. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 15.0 statistical analysis software. Results: Onset of sensory and motor blockade was significantly earlier in Group II (9±1.83 min) and (14.14±3.53min) as compared to Group I (11.94 ±2.59min) and (22.86±3.70min) and Group III(19±5.26min) and (27.14±4.07min). The requirement of first rescue analgesic was significantly earlier in Group III patients (211.43±23.25 min) followed by Group I (397±20.15 min) and last in Group II (632.43±23.15 min). Conclusion: Bupivacaine with Dexamethasone provided an early onset of sensory and motor blockade with maximum duration of blockade requiring rescue analgesic at a much later time period compared to Bupivacaine with Tramadol and Bupivacaine alone when used in supraclavicular brachial plexus block.   Keywords: Brachial plexus block, Bupivacaine, Tramadol, Dexamethasone.

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