Recurrent cardiac hydatid cysts ruptured intraoperatively during anesthetic induction for open-heart surgery

Introduction: Cardiac localization of hydatid disease is rare (<3%) even in endemic countries. Affection characterized by a long functional tolerance and a large clinical and paraclinical polymorphism. Serious cardiac hydatitosis because of the risk of rupture requiring urgent surgery. The diagnosis is based on serology and echocardiography. The aim of this work is to show one of the fatal complications of this condition which arose intraoperatively during anesthetic induction. Methods: We report the observation of a 37-year-old woman operated on in 2010 for a cardiac hydatid cyst presenting a recurrence of cardiac hydatid disease with two left intraauricular cysts expressed by palpitations with dyspnea. Preoperatively: dyspnea stage II of the NYHA. Chest x-ray: CTI at 0.58. ECG: RSR. Echocardiography: Two largest left atrial cysts: 47/40 mm compress the origin of the right pulmonary vein, 2nd cyst of 36/28 mm. The existence of another small caliber lateral cyst. Positive hydatid serology. The patient developed an anaphylactic shock of unexplained cause, which required the assistive CPB facility. Intraoperative exploration: The two ruptured cysts in the left atrium with multiple left intraatrial daughter vesicles. Gesture: Removal of daughter vesicles with sterilization with hypertonic saline. Results: The postoperative consequences were favorable despite a prolonged stay in intensive care following a picture of acute respiratory distress syndrome. Conclusion: Intracardiac rupture is a very serious complication and can produce dramatic pictures with sudden death. It can be responsible for allergic reaction, systemic embolism, pulmonary embolism and systemic metastases. Keywords: Hydatid Cyst; Heart; Relapsing; Rupture; Surgery; Anaphylactic Shock; Cardiopulmonary Bypass; Prevention

Effect of Anti-Emetic Combination of Sevoflurane / Propofol Anesthesia Technique in Laparoscopic Cholecystectomy

Objective: To assess symptoms of nausea and vomiting in laparoscopic cholecystectomy post-operatively, administered anesthesia by sevoflurane or propofol and to assess the effect of dexamethasone and ondansetron anti-emetic combination. Study design & Setting: It was an experimental study design conducted from 08-Oct-2017 till 11-Jul-2018 at Rawal General & Dental Hospital. Methodology: Patients were recruited in interventional groups by lottery method as n=160, with 80 cases allocated in each group. The patients with gallstones planned for laparoscopic cholecystectomy after preoperative assessment were classified to American Society of Anesthesiologist (ASA) physical status class I-II. All the patients placed in a particular ASA physical status class were (exposed to both induction methods) either anesthetic induction by propofol 1-2 mg/kg (group-A) or by employing sevoflurane 4-8% (group-B) in combination with oxygen, while maintenance was done in both study groups with 2% sevoflurane and 50% nitrous oxide in oxygen. After procedure patients stayed in post-anesthesia care unit where intra-operative monitoring was evaluated. The primary end point of the study was to note the rate of nausea and vomiting in 24 hours interval after surgery. Results: Both sevoflurane and propofol are equally effective anesthetic induction agents. The same combination of dexamethasone and ondansetron was given to both groups and so the actual effect of both anesthesia drugs in terms of side effects were nullified. Conclusion: In laparoscopic cholecystectomy, both sevoflurane and propofol are good enough when administered with dexamethasone and ondansetron anti-emetic combination, for post-operative nausea and vomiting up to 24 hours observation time in study.

Influence of the type of anesthesia on 111 arthrocentesis in temporomandibular joint disorders: results of a prospective study

Aims: Temporomandibular dysfunction is a generic term that covers a large number of clinical problems affecting not only TMJ (Temporomandibular Joint), but also the masticatory musculature and related structures. Arthrocentesis is the most commonly used technique in patients with pain or limitation of the oral opening due to joint causes in which conservative treatment has failed. It is generally performed under local anesthesia and sedation, although depending on the type of patient and the preferences of the surgeon it can also be performed under general anesthesia. Material and method: A prospective, observational, analytical cohort study has been carried out to evaluate if the type of anesthesia, the drugs used for sedation and whether or not anesthetic induction is performed during arthrocentesis influence the results of 111 arthrocentesis performed in patients with TMJ pathology. Results: In patients who arthrocentesis was performed with propofol without midazolam the improvement in pain at one week and one month postarthrocentesis was greater than propofol with midazolam was used. Conclusion: The type of anesthesia could influence the results of arthrocentesis.

Impact of Alternative Routes and Timing of Dopamine and Mannitol Administrations to Reduce Negative Properties of Extended Cardiopulmonary Bypass on Renal Function in Coronary Artery Operations

Objectives: To analyze impact of alternative routes and timing of dopamine and mannitol administrations to reduce negative properties of extended cardiopulmonary bypass on renal function in coronary artery operations. Methods: Set I (n: 26 individual): Mannitol (1 g/kg) has been introduced to the CPB priming solution. Set II (n: 25 patients): Even during interval among anesthetic induction and operation, 3 g/kg/min of IV dopamine was delivered. Group III (n = 25 patients): 2 g/kg/min IV dopamine was provided among anesthesia initiation and operation conclusion, and 1 g/kg mannitol were added to priming solution for CPB. Furosemide was administered to Group IV (n = 26 cases) when urine production was poor. Results: There would be a substantial rise in the post-operative urine microalbumin/creatinine ratios over all classes (p 0.06), as well as a rise in cystatin-c in Set 1, 2, and 3 (p 0.02). Conclusions: Researchers suggest that combining dopamine infusion (1 g/kg/min) and mannitol (2 g/kg) throughout CPB seems to be the more actual method for preventing detrimental possessions of CPB on renal functioning.

Comparison of different scales for the evaluation of anxiety and compliance with anesthetic induction in children undergoing scheduled major outpatient surgery

Introduction Anxiety in children triggered by a scheduled surgical intervention is a major issue due to its frequency and consequences. Preoperative anxiety is associated with increased patient fear and agitation on anesthetic induction. The aim of this study is to compare three preoperative anxiety scales for children undergoing elective outpatient surgery, and to correlate each of these tools with the degree of patient compliance on induction, as assessed by the Induction Compliance Checklist (ICC). Methods An observational prospective study was performed on a cohort of children with ages between 2 and 16 years old, scheduled for outpatient surgery. Anxiety was assessed upon arrival to the hospital (M0), during transfer to the surgical unit (M1), and in the operating room during anesthetic induction (M2). Anxiety in the parents (measured with the State-Trait Anxiety Inventory, STAI) and in the children (measured with the Spence Anxiety Scale-Pediatric, SCAS-P, the State-Trait Anxiety Inventory Children, STAIC, and Modified Yale Preoperative Anxiety Scale, m-YPAS) was assessed. Compliance with anesthetic induction was assessed with ICC. Results The study included 76 patients (72.4% male, median age 7.9 years). Anxiety scores (m-YPAS) increased as the moment of surgery approached, being greater at the entrance to the surgical unit (M0 = 26.1 ± 9.5; M1 = 31.8 ± 18.1; M2 = 33.5 ± 21.1). A strong correlation was found between ICC scale and m-YPAS at M1 (0.738) and M2 timepoints (0.794), but not with the rest of scales at M0. Conclusions Standard anxiety assessment scales do not predict the quality of anesthetic induction. m-YPAS scale can detect increasing anxiety in children as they approach the surgical procedure and this correlates strongly with a worse anesthetic induction, defined by higher score on ICC scale.

The Application of a SaCoVLMTM Visual Intubation Laryngeal Mask for the Management of Difficult Airways in Morbidly Obese Patients: Case Report

We report insertion of the SaCoVLMTM in three awake morbidly obese patients (BMI 46. 7–52.1 kg/m2). The patients were given intravenous atropine and midazolam injections after entering the operating room and then inhaled an anesthetic with 2% lidocaine atomization. After SaCoVLMTM insertion while patients were awake, when the vocal cords were visualized, controlled anesthetic induction commenced with spontaneous ventilation. The entire anesthesia induction and intubation process was completed under visualization, and no adverse events such as hypoxemia occurred. No patient had an unpleasant recall of the procedure. We conclude that the SaCoVLMTM is easy to use, well tolerated and suitable for awake orotracheal intubation in patients with known difficult airways.

Intraoperative Post Partum Hemorrhage in a Patient with Dengue Fever

A 33 year old obstetric patient with mild fever of undiagnosed etiology underwent emergency caesarean section under general anesthesia. She had platelet count of 98,000 per microliter and increased APTT of 37.8 s at the time of surgery. After uneventful anesthetic induction and delivery of fetus, slow and oozing type of bleeding led to massive hemorrhage. Patient remained vitally stable throughout perioperative phase and was extubated. Next day, patient’s dengue IgM antibody was reported positive. Neonate was well and his dengue test was negative. Pregnant women are at high risk of developing severe complications of dengue fever with unclear mechanisms related to impaired coagulation. Regional anesthesia may not have safe outcome due to dengue infection. doi: https://doi.org/10.12669/pjms.38.1.4519 How to cite this:Ahmed U, Aman A. Intraoperative Post Partum Hemorrhage in a Patient with Dengue Fever. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4519 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Delirium-The Effect of Children Anesthesiology after Surgery

Delirium of anesthesiology is a clinical phenomenon widespread in children. Although the pathophysiology is still uncertain, some factors seem to be involved, such as rapid awakening in an unknown environment, agitation during anesthetic induction, preoperative anxiety, environmental disorders, pre-anesthetic medication, and inhalational anesthetics. There remain unanswered questions and implications related to the emergence of delirium in children. Although we know that there are some predisposing factors to emergence delirium, we still cannot accurately identify those at most significant risk. Emergent delirium should be considered a ‘vital sign,’ which should be followed and documented in every child in the postanaesthesia recovery period. What should adopt standardized screening tools for pediatric emergence delirium (ED)