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Journal of clinical anesthesia 08/2012; 24(5):434-5. · 1.32 Impact Factor
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Indian journal of anaesthesia 01/2012; 56(1):83-5.
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ABSTRACT: Paravertebral block (PVB) has the potential to offer long-lasting pain relief because it can uniquely eliminate cortical responses to thoracic dermatomal stimulation. Benefits include a reduction in postoperative nausea and vomiting (PONV), prolonged postoperative pain relief, and potential for ambulatory discharge.
To compare PVB with local infiltration for postoperative analgesia following modified radical mastectomy (MRM).
Forty patients undergoing MRM with axillary dissection were randomly allocated into two groups. Following induction of general anesthesia in group P, a catheter was inserted in the paravertebral space and 0.3 ml/kg of 0.25 % of bupivacaine was administered followed by continuous infusion, while in group L, the surgical incision was infiltrated with 0.3 ml/kg of 0.25 % bupivacaine.
The statistical tests were applied as unpaired student 't' test/nonparametric test Wilcoxon Mann Whitney test for comparing different parameters such as VAS score and consumption of drugs. The categorical variables such as nausea and vomiting scores, sedation score, and patient satisfaction score were computed by Chi square test/Fisher exact test.
VAS score was significantly lower in group P than in group L throughout the postoperative period. The mean alertness score (i.e., less sedation) was higher in group P in the postoperative period than group L. The incidence of PONV was less in PVB group.
PVB at the end of the surgery results in better postoperative analgesia, lesser incidence of PONV, and better alertness score.
Journal of Anaesthesiology Clinical Pharmacology 01/2012; 28(1):76-80.
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ABSTRACT: A 46-year-old woman was anesthetized for total thyroidectomy. The thyroid was massive, deviating the trachea to the right and causing attenuation of the trachea radiologically. She had symptoms of respiratory obstruction in the supine position. Awake FOB-guided intubation was done in sitting position after airway topicalisation, and the airway was intubated with difficulty with 7.0 mm cuffed orotracheal tube. We describe this case in detail and discuss the significance of careful approach to planning and preparation in the management of such a case.
Case reports in anesthesiology. 01/2011; 2011:352672.
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ABSTRACT: Peripartum cardiomyopathy is an unusual form of dilated cardiomyopathy, which manifests as acute heart failure in the last trimester of pregnancy or early postpartum period. Its aetiology is currently unknown. The presenting signs and symptoms are those of congestive heart failure and more specifically those of left ventricular failure. Its importance lies in the fact that it has a high mortality rate and strikes the patient in the prime of life. Peripartum cardiomyopathy has far reaching implications for the anaesthesiologist. The reason for this is that many of the signs and symptoms of normal pregnancy are indistinguishable from mild cardiac failure so that the condition may remain undiagnosed and can present suddenly at the time of induction of anaesthesia or in the peri-operative period. The goals of anaesthetic management include avoidance of drug induced myocardial depression and prevention of increases in ventricular preload and afterload. Vigilant monitoring is essential throughout the surgery and in the postoperative period and the need for invasive monitoring should be assessed according to the clinical condition of the patient. It is important to recognise the association of cardiac failure and pregnancy as a separate syndrome so that peripartum cardiomyopathy can also be kept as a differential diagnosis for cardiac failure occurring in the peripartum period and a high index of suspicion should be maintained for the timely detection and management of this condition.
Journal of the Indian Medical Association 11/2010; 108(11):764-8.
