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Nasotracheal intubation is commonly performed for airway management during maxillofacial surgery. The semi-soft PVC tubes are known to cause upper airway injuries, including bleeding, avulsion of turbinates or nasal polyps. However, complete obstruction of the tube is a rare phenomenon. We report a case of an 18 years old male patient posted for fixation of fractured mandible in whom the inferior turbinate was avulsed while performing nasotracheal intubation. It occluded the endotracheal tube, resulting in ventilation failure which was successfully managed. We stress that if one encounters ventilation difficulty after nasal intubation, possibility of turbinate tissue occluding ETT lumen should be kept in mind and forceful ventilation must be avoided. "When in doubt, take it out". [ABSTRACT FROM AUTHOR]

Background and Objective: We wished to compare the endotracheal tube (ETT) cuff pressure inflated with air or alkalinized lignocaine during anesthesia and evaluate clinical symptoms such as coughing and sore throat (postoperative sore throat [POST]) following tracheal extubation. Materials and Methods: This was a prospective randomized controlled study conducted in a tertiary care set up over a period of 1 year. We included 100 patients in age group of 18-65 years posted for elective surgeries of duration more than 90 min under general anesthesia with N2O-O2 mixture. Patients were randomized using computer-generated randomization table into air and lignocaine group. The ETT cuff was inflated with air or alkalinized lignocaine (2% lignocaine with 7.5% sodium bicarbonate, in the proportions of 19.0:1.0 ml) to the volume that prevented air leak using cuff pressure manometer. After extubation, an independent observer blinded to study group recorded the presence or absence of coughing and POST at immediately, 1 h and 24 h postoperatively. Results: Demographic data, baseline characteristics (American Society of Anesthesiologists grade, intracuff volume/cuff pressure at start of surgery), and duration of anesthesia were comparable among study groups (P > 0.05). Cuff pressure and volume achieved in the end of surgery were much higher in air group as compared to lignocaine group (P < 0.05). Incidence of coughing and POST at immediately, 1 h and 24 h postoperatively was significantly higher in air group compared to lignocaine group. Impact of duration of anesthesia on rise in cuff pressure was significantly higher in air group and its effect on cuff-induced laryngotracheal morbidity was significant in both air and lignocaine group. Conclusion: This study showed the significance of use of alkalinized 2% lignocaine in prevention of rise of cuff pressure and incidence of coughing and POST. Duration of anesthesia has also a significant effect on incidence of postoperative trachea-laryngeal morbidity. [ABSTRACT FROM AUTHOR]

Background and Objective: Subclavian vein (SV) catheterization via infraclavicular approach is routinely done for multiple uses in operating rooms as well as in intensive care units in selected patients. The aim of this study was to evaluate the influence of shoulder position on central venous catheter (CVC) tip location during infraclavicular subclavian approach. Methodology: A prospective observational study was conducted on 60 patients and included American Society of Anesthesiologist (ASA) physical status 1 and 2 patients in whom CVC was planned. Catheters were introduced either in neutral shoulder position or the shoulder was lowered during venipuncture and guide wire insertion. A post-operative chest X-ray was done to note any complications and catheter tip malposition. Results: Demographic data was comparable between the two groups with respect to age, gender and weight. (P > 0.05). In one case in Group A and two cases in Group B there was failure to puncture the vein but this was statistically insignificant (P = 0.554). Failure to thread the guidewire was seen in one case in each group with no statistical significance (P > 0.05) Statistical difference was noted in successful placement of CVC tip between the two shoulder position (P = 0.025). Conclusion: The neutral shoulder position reduced the incidence of catheter misplacements during infraclavicular approach of right subclavian vein catheterization as compared to lowered shoulder position. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic surgery is associated with significant hemodynamic and pathophysiological changes due to creation of pneumoperitoneum. Clonidine is known to inhibit catecholamine and vasopressin release during pneumoperitoneum. This randomized, double-blinded, controlled study was conducted to evaluate the effect of administration of intravenous clonidine for the control of hemodynamic responses during the laparoscopic surgery and also to evaluate requirement of propofol during laparoscopic surgery. Methodology: 60 patients undergoing elective laparoscopic cholecystectomy were randomized into Group-C (clonidine group) and Group-S (saline group). In clonidine group patients received 3µg/kg of clonidine diluted in 10 ml saline over 10 minutes, while in saline group patients received 10 ml saline. Induction of anesthesia was same in both groups. Heart rate, systolic, diastolic blood pressure and mean arterial pressure were measured before premedication, before induction, after intubation, before CO2 insufflation, after insufflation and then subsequently at 15 min interval till desufflation and after extubation. Propofol requirement was calculated in both groups. Statistical Analysis: Unpaired 'T' test was used to compare both groups. Decision of applying unpaired t-test was based on normality test (Shapiro-Wilk). Results: Heart rate, systolic, diastolic and mean arterial blood pressures were significantly less in clonidine group as compared to control group. Intraoperatively there was significant heart rate variation in control group 82.93 ± 6.53/min to 96.13 ± 6.80/min than in clonidine group 86.30 ± 9.12/min to 73.13 ± 8.51/min (P<0.001). Mean blood pressure varied from 94.51 ± 4.82 mmHg to 102.18 ± 5.56 mmHg in control group while in clonidine group it varied from 94.14 ± 7.82 mmHg to 72.62 ± 1.87 mmHg. (P<0.001). Propofol requirement was significantly less in clonidine group. Conclusion: Administration of clonidine attenuates hemodynamic response to pneumoperitoneum and reduces the requirement of propofol. [ABSTRACT FROM AUTHOR]

Background & Objective: Tonsillectomy in children is the most commonly performed surgery in various otorhinolaryngology departments all over. Acute postoperative pain has adverse effects on the patients' morale as well as on physiological functions of the body. We aimed to compare the analgesic efficacy of diclofenac suppository over acetaminophen suppository for post tonsillectomy pain relief in pediatric age group. Methodology: 60 patients undergoing elective tonsillectomy were randomized into Group 'A' (diclofenac group) and Group 'B' (acetaminophen group). In diclofenac group patients received 2 mg/kg diclofenac, while in acetaminophen group patient received 20 mg/kg per rectum after induction of general anesthesia. Induction of anesthesia was same in both groups. Patients were monitored from 0 min (immediately after extubation, then after 10 min, 20 min and then 1 hourly till patients received rescue analgesic. Heart rate, mean arterial pulse, respiratory rate, pain at rest, pain on mouth opening, pain on swallowing and drowsiness were monitored. Pain was assessed by visual analogue scale (VAS) on a linear scale numbered from 0 to 10. Results: 14 (46.67%) patients needed rescue analgesic at 11th hr in Group-A, while 16 (53.33%) patients in Group-B needed it at 8th hr, the difference being statistically significant (P<0.001). Mean time to rescue analgesia in Group-A was 11.63 hrs and in Group-B was 7.53 hrs, the difference was statistically significant (P<0.001). Visual analogue score (VAS) between the two groups showed significant increase in mean VAS in Group-B as compared to Group-A which was statistically significant. (P < 0.001). Conclusion: We conclude that both diclofenac and acetaminophen suppositories were good postoperative analgesics when given by rectal route in pediatric age group undergoing tonsillectomy. Diclofenac sodium suppository provides better analgesia and its duration of action is longer as compared to acetaminophen suppository. [ABSTRACT FROM AUTHOR]

Melanotic neuroectodermal tumor of infancy is a relatively uncommon osteolytic-pigmented neoplasm that primarily affects the jaws of infants. We report a 5-month-old male child who presented with a swelling in the right upper tooth region of upper jaw in which we face difficult mask ventilation as well as difficult intubation. Wide surgical excision was performed under general anesthesia. The uneventful course of anesthesia in the presented case was due to the thorough systemic evaluation and careful anesthetic strategy. Patients of congenital epulis continue to pose challenge to anesthesiologist as a consequence of the potential difficult mask ventilation and intubation. We hereby present a case of congenital epulis repair using diode laser under general anesthesia. [ABSTRACT FROM AUTHOR]

Cornelia de Lange syndrome presents with various problems which include anatomical anomalies of face and extremities, cardiopulmonary and endocrine disorders, renal dysfunction, epileptic EEG waves, and mental retardation. Difficult airway and aspiration risk due to gastroesophageal reflux and poor esophageal motility are the main challenges in anesthesia management. The choice of anesthetic procedure must be carefully considered in view of these abnormalities. We report a 14 years old male child who was a known case of Cornelia De Lange Syndrome for dental extraction with restorations under general anesthesia. The uneventful course of the anesthesia in the presented case was due to the thorough systemic evaluation and careful anesthetic strategy. [ABSTRACT FROM AUTHOR]

Xeroderma pigmentosum (XP) is a rare autosomal recessive disease, which is characterized by hypersensitivity of the skin to ultraviolet (UV) radiation and progressive neurological complications. Inhalational anesthetic agents are avoided due to the possibility of inducing DNA damage and minimum use of muscle relaxants is done intraoperatively. These patients may have a potential difficult airway. We report a 6 yrs old male child who was a known case of xeroderma pigmentosa scheduled for a dental extraction under general anesthesia. The uneventful course of anesthesia in this case was due to a thorough systemic evaluation and careful anesthetic plan. [ABSTRACT FROM AUTHOR]

Patients with mitral stenosis associated with Pregnancy Induced Hypertension (PIH) continue to pose a challenge to anesthesiologist and could be associated with an unfavorable maternal as well as fetal outcome. Women with mitral stenosis often do not tolerate the cardiovascular demands of pregnancy. This increased volume load and tachycardia together cause the patients to deteriorate and advance from one New York Heart association (NYHA) class to another. We report a, 28 year female, who underwent cesarean section under combined spinal-epidural anesthesia (CSEA). The uneventful course of the anesthesia in the presented case was due to the thorough systemic evaluation and careful anesthetic strategy. [ABSTRACT FROM AUTHOR]

We report a case of 54 year male, a case of dilated cardiomyopathy with low ejection fraction who underwent Functional Endoscopic Sinus Surgery (FESS) under general anesthesia. Anesthetic management of such patients is always requires the highest level of expertise as they are usually complicated by progressive congestive cardiac failure (CHF). The uneventful course of the anesthesia in the presented case was related to the thorough systemic evaluation and careful anesthetic strategy. [ABSTRACT FROM AUTHOR]

Patients with sickle cell disease (SCD) may present to the anesthetist in different clinical settings like perioperative care, management of acute painful crisis and intensive therapy for acute respiratory failure. We describe the successful management of a 34-year-old female patient with SCD, posted for cholecystectomy with common bile duct exploration under general and epidural anesthesia. The importance of preoperative stabilization and careful anesthetic strategy is emphasized. [ABSTRACT FROM AUTHOR]

The article reports on the female patient with Melkersson-Rosenthal syndrome (MRS) citing her anesthetic management who underwent check curettage under spinal anesthesia.