The Laboratory Diagnostic Profile of SARS−CoV−2 (COVID−19) Patients & Associated Factors

Intubation of a patient with temporomandibular joint ankylosis is a challenge for every anaesthesiologist. Dependable anaesthetic technique is most desired by all anaesthesiologists. The purpose of the present article is to have a brief overview of temporomandibular joint ankylosis, its clinical features, management and to review literature demonstrating various intubation techniques available to an anaesthesiologist while managing patients with temporomandibular joint ankylosis.

Excision of intra-dural dorsal spine meningioma with intra-operative neuromonitoring in a patient with post-pneumonectomy status- an anaesthetic challenge

Post-pneumonectomy status is associated with various anatomical and physiological changes. Intra-operative neuromonitoring allows for safe neurosurgery with minimal neurological damage. Intra-operative neuromonitoring requires that the anaesthetic technique be modified taking into considerations the effects of various anaesthetic agents on evoked potentials to allow for optimal monitoring. We present a case of 65 year old female patient, with post-pneumonectomy status posted for excision of intra-dural D10 meningioma with intra-operative neuromonitoring. The case was successfully conducted with meticulous planning and preparation with complete excision of lesion and no neurological deficit post-operatively.

Role of multimodal anaesthetic in post-operative analgesic requirement for robotic assisted radical prostatectomy

Purpose: Robotic assisted laparoscopic radical prostatectomy (RARP) is considered as standard of care for surgical management of localised prostate cancer. Procedure specific postoperative pain management (PROSPECT) guidelines are available for open radical prostatectomy. There is a lack of evidence for optimal pain management protocol in patients undergoing robotic radical prostatectomy. This study investigates the impact of multimodal anaesthetic on post-operative analgesic requirements. Methods and materials: In our Institute, RARP is performed with a multimodal anaesthetic technique. Forty-one consecutive cases from October 2018 to March 2019 operated on by the same surgeon and anaesthetised by the same anaesthetic consultant were included in the study. All the patients received standardised multimodal anaesthetic technique. Data from visual analogue pain scores, nausea, vomiting and requirement of analgesics were collected from hospital records and results were analysed. Results: Our results showed that 60% of patients reported either no pain or mild pain. None of the patients required stronger opioids or parenteral analgesic. Only three patients required antiemetic. Length of hospital stay was 1.19 days which is comparable to published outcomes from high volume centres performing RARP. Conclusion: Our study adds to the currently published literature that RARP when combined with the multimodal anaesthetic technique can significantly reduce stronger opioid analgesic requirement in the post-operative period without compromising LOS.

Total Intravenous Anaesthesia with Ketamine, Medetomidine and Midazolam as Part of a Balanced Anaesthesia Technique in Horses Undergoing Castration

To evaluate the use of ketamine-medetomidine-midazolam total intravenous infusion as part of a balanced anaesthetic technique for surgical castration in horses. Five healthy Standardbred cross colts were premedicated with IV acepromazine (0.01–0.02 mg/kg), medetomidine (7 µg/kg) and methadone (0.1 mg/kg) and anaesthesia induced with IV ketamine (2.2 mg/kg) and midazolam (0.06 mg/kg). Horses were anaesthetised for 40 min with an IV infusion of ketamine (3 mg/kg/h), medetomidine (5 µg/kg/h) and midazolam (0.1 mg/kg/h) while routine surgical castration was performed. Cardiorespiratory variables, arterial blood gases, and anaesthetic depth were assessed at 5 to 10 min intervals. Post-anaesthesia recovery times were recorded, and the quality of the recovery period was assessed. The anaesthetic period and surgical conditions were acceptable with good muscle relaxation and no additional anaesthetic required. The median (range) time from cessation of the infusion to endotracheal tube extubation, head lift and sternal recumbency were 17.2 (7–35) min, 25 (18.9–53) min and 28.1 (23–54) min, respectively. The quality of anaesthetic recovery was good, with horses standing 31.9 (28–61) min after the infusion was ceased. During anaesthesia, physiological variables, presented as a range of median values for each time point were: heart rate 37–44 beats/min, mean arterial pressure 107–119 mmHg, respiratory rate 6–13 breaths/min, arterial partial pressure of oxygen 88–126 mmHg, arterial partial pressure of carbon dioxide 52–57 mmHg and pH 7.36–7.39. In conclusion, the co-administration of midazolam, ketamine and medetomidine as in IV infusion, when used as part of a balanced anaesthetic technique, was suitable for short term anaesthesia in horses undergoing castration.

Anaesthesia Experience for Breast Surgery with Ultrasound-Guided Pecs Block II in High-Risk Elderly Patients - Two Case Reports

The incidence of breast cancer has increased significantly over recent years.1 Surgery is the gold standard treatment for most cases, and general anaesthesia (GA) is the preferred anaesthetic technique. However, regional anaesthesia may be an alternative to GA in multimodal regimens in high-risk patients to avoid GA-related cardiovascular or pulmonary side effects.2 The use of neuraxial techniques [thoracic epidural or thoracic paravertebral block (TPVB)] or an intercostal nerve block can therefore be suggested.3 However, novel approaches that are easier, safer, and more effective have been proposed to overcome possible complications and difficulties of these techniques. One approach, the pectoral nerve (Pecs) II block, is a fascial plane block that has shown promising results in anterolateral chest wall 2 analgesia.3,4 The aim of this technique is to block the pectoral nerves, intercostobrachial, intercostals3- 6 and the long thoracic nerve.4 The Pecs block II has been used successfully as part of the multimodal regimen for postoperative analgesia, but not yet as a primary anaesthetic technique in breast surgery.3 Here, we describe breast cancer resection with ultrasound (US)-guided Pecs block II and sedation in two high-risk elderly patients. Both patients provided written consent for publication of the case reports and related images. Here, we present two breast cancer resection cases with multiple comorbidities who underwent ultrasound-guided Pecs II blocks under sedation. Additional analgesic and / or local anaesthetic infiltration was required for parasternal region pain (simple mastectomy, Case 1) and axillary region pain (sentinel node biopsy, Case 2). However, Pecs II blocks may not block the anterior cutaneous intercostal nerve branches or the intercostobrachial nerve in operations involving the medial part of the breast or extending to the axilla.