Tarang Jain

Abstract

Pharyngeal mass often presents to the anaesthesiologist for airway management and anaesthesia, needed to aid in diagnosis or treatment. These patients present a challenge to the anaesthesiologist as they block the pathway for ventilation as well as intubation. Spindle cell carcinomas are rare tumors with very few cases of oropharyngeal spindle cell carcinomas reported. These tumors of the pharynx usually present as pedunculated masses of less than 2 cm in size. The anesthetic management for excision is usually simple. We report a unique case of a large size 5 cm pedunculated oro pharyngeal mass, which was mobile causing dynamic airway obstruction. A thorough pre operative examination and planning for the airway management lead to anticipation of difficulties and easy navigation through them. Keywords: Tongue profusion, Oropharyngeal mass, Anaesthetic management, Difficult airway.

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Abstract

Neonates are given anaesthesia for multiple surgeries, however coupling neonatal physiology with child physiology is a common error made. Circulation changes at birth from the foetal to adult type, but neonates are prone to revert to foetal circulation with disastrous effects. This phenomenon is known as flip flop or YoYo circulation. We report a case of a premature neonate, being operated for intestinal perforation, with Yo Yo circulation intraoperatively. Keywords: Neonate anaesthesia, Flip flop circulation, Yo Yo circulation, Neonatal surgery, Desaturation, Hypoxia.

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Abstract

Introduction and Aims: Airway management in a patient with cervical spine injury is considered a challenge. Minimizing neck movement and maintaining head in neutral position is essential to prevent secondary neurological injury. Flexible fibreoptic intubation causes minimal cervical spine movement. In this study, we evaluated and compared orotracheal and nasotracheal flexible fibreoptic intubation in a patient with simulated cervical spine injury (using a cervical collar), under conscious sedation. Materials and Methods: Sixty patients were randomly allocated into oral and nasal groups. After premedication and preperation with Xylometazoline nasal drops and lignocaine nebulization, bolus fentanyl and propofol infusion was started to achieve concious sedation. Flexible fibreoptic intubation was performed orally or nasally, after placement of a cervical collar. Operator ease and hemodynamics were monitered. Result: In the oral group, 86.7% and in the nasal group, 93.3% first attempts were successful. The ease of fibreoptic intubation was graded to be excellent in a significantly greater number of patients in the nasal group as compared to the oral group. Hemodynamic variability though present was not clinically relevent, this might have been secondary to use of adequate sedation. Conclusion: The ease of fibreoptic intubation in simulated cervical spine injury, under conscious sedation was found to be significantly better in the nasotracheal group. Hemodynamic stability was demonstrated in both the groups in our study. Keywords: Cervical spine, Simulated cervical spine, Fibreoptic intubation, Oral fibreoptic intubation, Nasal fibreoptic intubation, Conscious sedation.

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