Rachna Wadhwa

Abstract

Background: The obstetric population has been most vulnerable in this COVID-19 pandemic. We could not retrieve any study evaluating the safety and efficacy of anaesthetic techniques in parturients with COVID-19 undergoing caesarean delivery (CD) from South Asian Sub-continent. We, herein present the detailed clinical analysis and anaesthetic management of a case series of seven parturient with COVID-19 undergoing CD under subarachnoid block (SAB) in a tertiary care designated COVID hospital in the city of Delhi between June and December 2020. Case Presentation: Herein, we report 7 parturients with mild COVID-19 disease undergoing CD under SAB. Our observations are that the use of SAB was associated with transient haemodynamic perturbations in terms of hypotension in 3 patients and bradycardia in one patient. The neonatal outcome was observed to be favourable. Conclusions: To conclude, our experience is that SAB is safe and effective for parturient with mildly symptomatic COVID-19 disease; however, was found to be associated with transient haemodynamic changes exclusively in parturients with anaemia.    Keywords:COVID- 19 disease, Caesarean delivery, Subarachnoid block

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Abstract

Thymic mass is a rare tumor in the anterior mediastinum. They are usually of unknown etiology. About 50% of patients are diagnosed incidentally on chest radiographs. A  45 years, BMI-28, male patient presented to cardiac outpatient department with breathlessness and persistent cough for past three months. He also complained of generalized fatigue and nonspecific chest pain. On chest x-ray (PA view), there were diffuse opacities in middle and lower zone and no tracheal compression or deviation. Lateral neck X-ray also ruled out any airway compression. Computed tomography thorax revealed a huge mass occupying the prevascular compartment of mediastinum and insinuating the visceral compartment bilaterally with extension upto bilateral cardiophrenic and anterior costophrenic angles. CT-guided biopsy was consistent with thymolipoma which was surgically resected. Thymolipomas usually present with nonspecific symptoms. They pose a huge anaesthetic challenge during the peri-operative period in terms of difficult intubation, co-existing airway compression requiring reinforced tubes and fiberoptic guidance, the possibility of sudden airway collapse post-induction, risk of hypoxemia secondary to reduced functional residual capacity (FRC) and haemodynamic disturbances during and after removal of huge mass.   Keywords: Anterior mediastinal mass, Mediastinal widening, Tumor of the thymus.

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Abstract

Theanterior approach to the cervical spine is commonly utilized for a variety of degenerative, neoplastic, traumatic, and infectious indications. The distinctive anatomy of the anterior neck presents a unique set of hazards. We encountered a case of delayed esophageal perforation after cervical spine surgery, who presented to us forty-two days post-surgery. Although, timely detection and management of esophageal perforation has a good prognosis, associated vascular complications added on to airway management challenges. We outline the issues with diagnosis and key aspects of airway management in this patient. Keywords: Cervical spine surgery, Esophageal perforation, Difficult airway, Tracheostomy.

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