Pituitary gland is responsible for maintaining the milieu interior of the body. An adenomatous gr... more Pituitary gland is responsible for maintaining the milieu interior of the body. An adenomatous growth of the gland may cause hypo- or hypersecretion of various hormones The disturbance of hormone secretion may result in various physical, physiological, and anatomical abnormalities. All these changes have profound influence on anesthesia management. Under conditions of hyposecretion, the anesthesiologist should ensure that in a nonemergent situation, the patient’s hormonal profile has been restored to normal by replacement therapy. Similarly, in the presence of hypersecretion, various physiological and biochemical disturbances should be optimized before anesthetizing the patient. Almost all adenomas are removed by the transsphenoidal route, an approach that poses unique challenges to the anesthesiologist. Postoperatively, patients may develop complications specific to this surgical procedure like cerebrospinal fluid leak, diabetes insipidus, hyponatremia, and hormonal deficiency. Postoperative management in the neurosurgical intensive care requires a team approach that includes the neurosurgeon, neuroanesthesiologist, and endocrinologist.
A case report describing anesthetic management of a child suffering from cancrum oris is describe... more A case report describing anesthetic management of a child suffering from cancrum oris is described. The patient presented with respiratory obstruction with necrotic lesions of the skin surrounding the mouth and of oral mucosa. Generalised septicemia was present. It was not possible to pass an endotracheal tube and anesthesia was therefore achieved with intravenous infusion of ketamine without the use
With the aim of defecting the potential hazard of air embolism, end tidal carbon dioxide (ETCO2) ... more With the aim of defecting the potential hazard of air embolism, end tidal carbon dioxide (ETCO2) was monitored in 238 patients undergoing neurosurgery (in the sitting position), for early detection of venous air embolism (VAE). Fifty six episodes (26.3%) of significant fall in ETCO2 were observed in 41 patients (17.2%). Haemodynamic disturbances occurred in only 26 patients (10.9%) and were always preceded by a fall in ETCO2. Thirteen patients had positive air aspiration and cardiac murmurs were heard in only six. One patient suffered severe hypoxaemia (PaO2 = 55 mm Hg) whereas two had severe haemodynamic disturbances, but could be promptly resuscitated.
Potassium homeostasis was studied in 30 patients undergoing cardiac surgery by employing cardiopu... more Potassium homeostasis was studied in 30 patients undergoing cardiac surgery by employing cardiopulmonary bypass (CPB) and moderate hypothermia, and using morphine, N2O, relaxant anaesthesia. There was a trend for hypokalemia, and for maintaining a K+ level of 4-4.5 mmol/l, K+ infusion was required during CPB (9.017 mmol/m2 BSA/h). K+ infusion required in the post-operative period was considerably less (1.532 mmol/m2 BSA/h). There was no significant difference in the K+ levels of patients receiving preoperative diuretic therapy, as compared to those not receiving such therapy. Potassium requirement was significantly higher in patients under-going CABG and valvular heart disease, as compared to congenital heart disease. The mean urinary loss of K+ during bypass was found to be 2.95 mmol/m2 BSA/h, which was only 32 per cent of that required to be infused (9.017 mmol/m2 BSA/h). The mean excretion of K+ in the post operative period was significantly higher (4.53 mmol/m2 BSA/h) than K+ re...
Myelomeningocele with Chiari II malformation and hydrocephalus is a common association seen in in... more Myelomeningocele with Chiari II malformation and hydrocephalus is a common association seen in infants with a congenital failure of neurulation. Here we report two cases of such an association presenting with different sets of problems. The first patient presented with severe inspiratory stridor due to bilateral abductor vocal cord paralysis, which was relieved completely within 24 h of definitive surgery. The second patient experienced intraoperative cardiac arrest. Definitive surgery was followed after successful cardiopulmonary resuscitation. The cause of the perioperative sequence of events in both cases is attributed to the associated pathologies of Chiari II malformation.
The tunnelling phase of ventriculoperitoneal shunt insertion is the most painful part but patient... more The tunnelling phase of ventriculoperitoneal shunt insertion is the most painful part but patients are often given inadequate opioid analgesic for fear of post operative delayed recovery and/or respiratory depression. This may result in an increase in intracranial pressure. Twenty adults scheduled to undergo ventriculoperitoneal shunt insertion were administered standard anaesthesia. Monitoring included heart rate, electrocardiogram, end-tidal carbon dioxide, invasive blood pressure, and oxygen saturation. Intracranial pressure was monitored by placing the ventricular end of shunt catheter in the dilated lateral ventricle. Five minutes before tunnelling, fentanyl 1 microg kg(-1) was administered. Mean arterial pressure, heart rate and intracranial pressure were recorded during tunnelling and subsequently at 1-min interval for 5 min. Data were analysed using t-test and repeated measured test. Tunnelling caused significant increase in mean arterial pressure (from 81.4 +/- 11.0 to 110.9 +/- 15.3 mmHg, P < 0.05), intracranial pressure (from 21.4 +/- 8.1 to 29.2 +/- 12.5 mmHg, P < 0.05) and heart rate (from 74.4 +/- 13.8 to 94.1 +/- 17.8 beats min(-1), P < 0.05). Whereas, the increase in haemodynamic parameters persisted for 3 min post-tunnelling, elevated intracranial pressure lasted for 2 min. Tunnelling significantly increases intracranial pressure and blood pressure despite prior fentanyl administration. This may be deleterious in the presence of intracranial pathology.
Pituitary gland is responsible for maintaining the milieu interior of the body. An adenomatous gr... more Pituitary gland is responsible for maintaining the milieu interior of the body. An adenomatous growth of the gland may cause hypo- or hypersecretion of various hormones The disturbance of hormone secretion may result in various physical, physiological, and anatomical abnormalities. All these changes have profound influence on anesthesia management. Under conditions of hyposecretion, the anesthesiologist should ensure that in a nonemergent situation, the patient’s hormonal profile has been restored to normal by replacement therapy. Similarly, in the presence of hypersecretion, various physiological and biochemical disturbances should be optimized before anesthetizing the patient. Almost all adenomas are removed by the transsphenoidal route, an approach that poses unique challenges to the anesthesiologist. Postoperatively, patients may develop complications specific to this surgical procedure like cerebrospinal fluid leak, diabetes insipidus, hyponatremia, and hormonal deficiency. Postoperative management in the neurosurgical intensive care requires a team approach that includes the neurosurgeon, neuroanesthesiologist, and endocrinologist.
A case report describing anesthetic management of a child suffering from cancrum oris is describe... more A case report describing anesthetic management of a child suffering from cancrum oris is described. The patient presented with respiratory obstruction with necrotic lesions of the skin surrounding the mouth and of oral mucosa. Generalised septicemia was present. It was not possible to pass an endotracheal tube and anesthesia was therefore achieved with intravenous infusion of ketamine without the use
With the aim of defecting the potential hazard of air embolism, end tidal carbon dioxide (ETCO2) ... more With the aim of defecting the potential hazard of air embolism, end tidal carbon dioxide (ETCO2) was monitored in 238 patients undergoing neurosurgery (in the sitting position), for early detection of venous air embolism (VAE). Fifty six episodes (26.3%) of significant fall in ETCO2 were observed in 41 patients (17.2%). Haemodynamic disturbances occurred in only 26 patients (10.9%) and were always preceded by a fall in ETCO2. Thirteen patients had positive air aspiration and cardiac murmurs were heard in only six. One patient suffered severe hypoxaemia (PaO2 = 55 mm Hg) whereas two had severe haemodynamic disturbances, but could be promptly resuscitated.
Potassium homeostasis was studied in 30 patients undergoing cardiac surgery by employing cardiopu... more Potassium homeostasis was studied in 30 patients undergoing cardiac surgery by employing cardiopulmonary bypass (CPB) and moderate hypothermia, and using morphine, N2O, relaxant anaesthesia. There was a trend for hypokalemia, and for maintaining a K+ level of 4-4.5 mmol/l, K+ infusion was required during CPB (9.017 mmol/m2 BSA/h). K+ infusion required in the post-operative period was considerably less (1.532 mmol/m2 BSA/h). There was no significant difference in the K+ levels of patients receiving preoperative diuretic therapy, as compared to those not receiving such therapy. Potassium requirement was significantly higher in patients under-going CABG and valvular heart disease, as compared to congenital heart disease. The mean urinary loss of K+ during bypass was found to be 2.95 mmol/m2 BSA/h, which was only 32 per cent of that required to be infused (9.017 mmol/m2 BSA/h). The mean excretion of K+ in the post operative period was significantly higher (4.53 mmol/m2 BSA/h) than K+ re...
Myelomeningocele with Chiari II malformation and hydrocephalus is a common association seen in in... more Myelomeningocele with Chiari II malformation and hydrocephalus is a common association seen in infants with a congenital failure of neurulation. Here we report two cases of such an association presenting with different sets of problems. The first patient presented with severe inspiratory stridor due to bilateral abductor vocal cord paralysis, which was relieved completely within 24 h of definitive surgery. The second patient experienced intraoperative cardiac arrest. Definitive surgery was followed after successful cardiopulmonary resuscitation. The cause of the perioperative sequence of events in both cases is attributed to the associated pathologies of Chiari II malformation.
The tunnelling phase of ventriculoperitoneal shunt insertion is the most painful part but patient... more The tunnelling phase of ventriculoperitoneal shunt insertion is the most painful part but patients are often given inadequate opioid analgesic for fear of post operative delayed recovery and/or respiratory depression. This may result in an increase in intracranial pressure. Twenty adults scheduled to undergo ventriculoperitoneal shunt insertion were administered standard anaesthesia. Monitoring included heart rate, electrocardiogram, end-tidal carbon dioxide, invasive blood pressure, and oxygen saturation. Intracranial pressure was monitored by placing the ventricular end of shunt catheter in the dilated lateral ventricle. Five minutes before tunnelling, fentanyl 1 microg kg(-1) was administered. Mean arterial pressure, heart rate and intracranial pressure were recorded during tunnelling and subsequently at 1-min interval for 5 min. Data were analysed using t-test and repeated measured test. Tunnelling caused significant increase in mean arterial pressure (from 81.4 +/- 11.0 to 110.9 +/- 15.3 mmHg, P < 0.05), intracranial pressure (from 21.4 +/- 8.1 to 29.2 +/- 12.5 mmHg, P < 0.05) and heart rate (from 74.4 +/- 13.8 to 94.1 +/- 17.8 beats min(-1), P < 0.05). Whereas, the increase in haemodynamic parameters persisted for 3 min post-tunnelling, elevated intracranial pressure lasted for 2 min. Tunnelling significantly increases intracranial pressure and blood pressure despite prior fentanyl administration. This may be deleterious in the presence of intracranial pathology.
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