Anesthesia Methods in Pregnant Women: A Review Study

Background: Manage and deal with the pregnant patient undergoing anesthesia for surgical non-obstructed surgery, assess the effects of non-obstetric surgeries on both fetus and mother during pregnancy, and measures to prevent it. Methods: A review search study was currently managed in PubMed, MEDLINE, Embase, Science gate, Elsevier, Scientific report, Google Scholar, and Cochrane Evidence-Based Medicine Reviews, after obtaining approval from the ethics committee of Tehran University of Medical Sciences. All the reviews identified were restricted to human studies and available in English. Results: Elective surgery ideally should be avoided during pregnancy while emergency surgery should proceed with consideration for the anesthetic implications of the altered physiology of pregnancy. Caution must be taken during anesthetic application and Airway management. Conclusion: Pre-oxygenation is essential and consider the rapid-sequence induction accompanied with cricoid pressure to lower the incidence of aspiration. Lower MAC values of the volatile anesthetic should be used and medications titrated to preferably produce beneficial effects only.

A Case of Unanticipated difficult Intubation in a patient posted for C5-C6 Posterior Fixation

Management of a “difficult airway” poses one of the most relevant and challenging tasks for anesthesiologists. Unanticipation with difficult airway and endotracheal intubation during the conduction of general anesthesia may result in complications and fatality. We report the case of a 14 yr old boy for planned C5-C6 spine fixation under general anaesthesia. Unanticipated difficult oral intubation after three failed attempts, managed by a stylleted cuffed endotracheal tube, head up tilt of the operation table, shoulder support, cricoid pressure and rotation of the endotracheal tube anticlockwise at the glottic opening.

Epidural catheter migration during cesarean

Background Early detection and vigilance of high spinal anesthesia post epidural catheter migration in cesarean section leads to safe conduct of anesthesia. Our case describes the migration of a previously functioning epidural catheter in the subarachnoid space. This migration can be explained by patient posture changes and movements. Case presentation A 32 year – old G2P0 medically free female parturient (height 160cm, weight 65 kg), admitted to the labor ward with a 4 cm cervical dilatation, an epidural catheter was inserted in the L3-4 space, and an aspiration test was negative for CSF/blood through epidural catheter. Epidural catheter was fixed on her back using sterile dressings. Epidural mixture of 0.1% bupivacaine and fentanyl 2 mcg/ml started. Due to fetal distress, cesarean section was urgently planned. She was given a bolus dose through the epidural catheter,10 minutes after skin incision, the patient suddenly started to complain of difficulty of breathing and drowsiness. Moreover, her oxygen saturation suddenly started to drop so rapid sequence induction with cricoid pressure applied and was performed till she was intubated. Her pupils were reactive and dilated. She had stable vital signs. She was reversed with neostigmine and atropine after the use of nerve stimulator. Aspiration from the epidural catheter was performed. A clear 10mls fluid was aspirated. The fluid was sent to the lab for analysis and found to be CSF. Upon extubation, the patient was conscious and obeying commands. She completely recovered the motor power of her upper and lower limbs while she was admitted to ICU for observation and she was discharged the next day without any residual anesthesia. Conclusion Aspiration test and epinephrine test dose is always recommend to be performed prior to local epidural anesthetic for cesarean section even if the function of the epidural catheter was previously established. Careful observation of neurologic signs is also important.

Rapid sequence induction: where did the consensus go?

Background Rapid Sequence Induction (RSI) was introduced to minimise the risk of aspiration of gastric contents during emergency tracheal intubation. It consisted of induction with the use of thiopentone and suxamethonium with the application of cricoid pressure. This narrative review describes how traditional RSI has been modified in the UK and elsewhere, aiming to deliver safe and effective emergency anaesthesia outside the operating room environment. Most of the key aspects of traditional RSI – training, technique, drugs and equipment have been challenged and often significantly changed since the procedure was first described. Alterations have been made to improve the safety and quality of the intervention while retaining the principles of rapidly securing a definitive airway and avoiding gastric aspiration. RSI is no longer achieved by an anaesthetist alone and can be delivered safely in a variety of settings, including in the pre-hospital environment. Conclusion The conduct of RSI in current emergency practice is far removed from the original descriptions of the procedure. Despite this, the principles – rapid delivery of a definitive airway and avoiding aspiration, are still highly relevant and the indications for RSI remain relatively unchanged.

Case report and review of literature of a rare congenital disorder: Adams-Oliver syndrome

Background Adams-Oliver syndrome is characterized by the combination of congenital scalp defects and terminal transverse limb defects. In some instances, cardiovascular malformations and orofacial malformations have been observed. Little is written with regards to the anesthetic management and airway concerns of patients with Adams-Oliver syndrome. Case presentation A five-year-old female with Adams-Oliver syndrome presented for repeat lower extremity surgery. Airway exam was significant for dysmorphic features, such as hypertelorism, deviated jaw, and retrognathia. Video laryngoscope was utilized for intubation due to the patients retrognathic jaw, cranial deformities, and facial dysmorphism. A vein finder with ultrasound guidance was needed to place the peripheral intravenous line due to her history of difficult intravenous access. The patient was successfully intubated with slight cricoid pressure applied to direct the endotracheal tube smoothly. Surgery and recovery were both unremarkable. Conclusions Due to varying presentations of Adams-Oliver syndrome, anesthetic and airway management considerations should be carefully assessed prior to surgery. Anesthesiologists must take into consideration possible orofacial abnormalities that may make intubation difficult. Amniotic band syndrome and other limb defects could potentially impact intravenous access as well.