RESUMEN

Angiotensin-converting enzyme inhibitors associated angioedema involving the upper aerodigestive tract is indisputably a hazardous airway condition which is clinically poorly recognized and frequently underestimated. We describe and present case of a 70-year old man on ramipril who developed massive tongue swelling post-operatively after unremarkable laryngeal mask anaesthesia which was fortuitously managed conservatively. High index of suspicion, timely recognition and knowledge of pathophysiology and the clinical course should guide airway and further supportive management in these patients.

RESUMEN

Pediatric LDLT using donors with unfavorable vascular anatomy is challenging in terms of donor safety, and complexity of reconstruction in the recipient. We describe an innovative technique of hepatic venous outflow reconstruction involving the recipient RHV, in the presence of a rudimentary RHV in the donor. The postoperative course of the donor and recipient was uneventful with satisfactory venous outflow in both. This technique avoided the use of prosthetic material, an important consideration given the recipient age and requirement for growth. This shows that donors previously considered unsuitable for donation can be utilized safely as long as principles of vascular anastomosis are adhered to. Moreover, it highlights that innovation is sometimes necessary to avoid compromise in donor safety.

Asunto(s)

RESUMEN

A 56-year-old man with a rotator cuff injury, scheduled for arthroscopic reconstruction surgery, had a history of recurrent symptoms of eyeball pain and blurred vision for several years. After close examination, he was diagnosed with Posner-Schlossman syndrome. Three weeks before the scheduled surgery, his intraocular pressure (IOP) increased (> 30 mmHg) and he became extremely anxious about the surgery. We monitored his IOP intraoperatively and successfully completed general anesthesia without any sequelae. As Posner-Schlossman syndrome can present with severe complications that may lead to postoperative visual loss, intraoperative monitoring of intraocular monitoring and careful anesthetic management are crucial to protect vision.

RESUMEN

BACKGROUND: The square root of time (SqRT) model had been used to predict the uptake of volatile agents. METHODS: We studied the rate of uptake of isoflurane in 10 patients using liquid isoflurane infusion through syringe pump into the closed circuit. The infusion rates were titrated to maintain a constant end tidal concentration of isoflurane of 1.5%. The predicted uptake values were also calculated from the square root principle and compared with the derived uptake. RESULTS: The observed rate of uptake was higher than predicted from the Lowe and Ernst equation (P<0.001). There exists considerable inter-individual variability in uptake pharmacokinetics and it showed statistically significant correlation with ideal body weight, body weight (P<0.01), body surface area, and body weight¾ from 30 min of start of isoflurane infusion (P<0.05). CONCLUSION: SqRT model is inaccurate in predicting isoflurane uptake and underestimates it during closed circuit anaesthesia.

Asunto(s)

RESUMEN

Anomalous origin of the right coronary artery (AORCA) is a rare congenital anomaly with an incidence of 0.92% during routine cardiac catheterization. Its presence raises an important concern to the anaesthesiologist because it can lead on to myocardial ischaemia manifesting as either angina pectoris or myocardial infarction, or sudden death in young patients with minimal exertion, even in the absence of atherosclerosis. Patients with AORCA may be intolerant to stress and the high cardiac output condition owing to volume loading. Such a therapeutic manoeuvre may be desirable during renal transplantation to enable better perfusion of the renal graft immediately after grafting the kidney, in order to improve its function. Hence, haemodynamic goals in renal transplant recipient with AORCA can be contradictory during surgery, thereby rendering anaesthetic management challenging. We report a case of acute myocardial ischemia precipitated by fluid loading conditions in a patient with AORCA during renal transplant that was successfully treated with emergent intra-aortic balloon pump therapy intraoperatively. Judicious intraoperative fluid replacement is recommended, and volume overload must be avoided in AORCA patients undergoing surgery.

Asunto(s)

RESUMEN

Anterior cervical location of arachnoid cyst is a rare and only 22 cases have been reported in the literature. The surgical approach was quite varied and mostly these cysts were accessed via dorsal laminectomy, with few patients developing postoperative neurological deficit. We report a 51-year-old male with a cervical arachnoid cyst extending from the dens to the inferior border of the C3 body, which was successfully decompressed via an anterior cervical approach through the partial corpectomy of C2. This is probably the first case report demonstrating the safety of anterior partial median corpectomy of the C2 body with micro discectomy of C2-C3 space for excision of the anterior cervical archnoid cyst. The additional advantage of this procedure is that it may not result in spinal instability.

Asunto(s)

Asunto(s)

RESUMEN

BACKGROUND: The usage of high fresh gas flows with expensive volatile agents is known to cause substantial economic losses. Practicing low flow anesthesia can minimize these costs. The average costs of different anesthetic techniques, used for maintenance of general anesthesia and the frequency of use of low flows were evaluated. METHODS: We noted the consumption of anesthetic gases and volatile agents during routine surgeries in our institute for two weeks (10 consecutive full working days). According to the anesthetic agent and fresh gas flow used, all general anesthetics were divided into four groups i.e. low flow (gas flows < or = 1 L/min) and high flow anesthesia (gas flows > 1 L/min) with isoflurane, halothane anesthesia (gas flows > 1 L/min) and propofol intravenous anesthesia (gas flows > 1 L/min). We calculated the individual cost of maintenance of anesthesia on per hour basis for each group based on average flows and anesthetic concentrations used. RESULTS: Low flow anesthesia is sparingly used in our institution (4.1%). Halothane with fresh gas flow > 1 L/min is the most commonly used anesthetic technique (45.9%). Propofol anesthesia was nearly equal to low flow isoflurane anesthesia in terms of costs. Using higher fresh gas flows with isoflurane increases this cost by three times. CONCLUSIONS: Low flow anesthesia is still sparingly used. Low flow isoflurane anesthesia is equivalent in terms of costs to propofol anesthesia though more expensive than conventional anesthesia with halothane.

Asunto(s)