Anaesthesia and deep brain stimulation

Deep brain stimulation (DBS) is becoming an increasingly popular minimally invasive surgical procedure for various movement disorders, especially Parkinson’s disease. Different nuclei have been identified depending on patients’ symptoms, but the success or failure of the procedure depends on various other factors such as proper patient selection and risk-benefit analysis. While various techniques of anaesthesia including monitored anaesthesia care, conscious sedation and general anaesthesia are being used routinely, no clear-cut evidence exists as to the best technique for this procedure. This review article discusses the surgical procedure of DBS, devices currently available, perioperative anaesthetic concerns and techniques, effect of anaesthetic drugs on microelectrode recordings and macro-stimulation and associated complications

Anesthetic considerations and successful management of a patient with permanent pacemaker for cervical spine instrumentation

Patients with permanent pacemaker posted for cervical spine instrumentation pose special challenges for modern-day anesthesiologist since the field of surgery is in proximity to the pacing apparatus. The important considerations in this regard are pacemaker dependency, prior reprogramming to asynchronous mode, perioperative interference with pacemaker function due to electrolyte, acid-base disturbances, and electromagnetic interference leading to pacemaker failure and hemodynamic compromise. We report successful anesthetic management of a patient of postlaminectomy kyphosis with compressive myelopathy with permanent pacemaker in situ who underwent C5–C6 corpectomy and instrumentation under general anesthesia

Sudden infant death syndrome (SIDS) - The role of trigemino-cardiac reflex: A review

Sudden infant death syndrome (SIDS) is an unexplained death in infants that usually occurs during sleep. The cause of SIDS remains unknown and multifactorial. In this regard, the diving reflex (DR), a peripheral subtype of trigeminocardiac reflex (TCR) is also hypothesized as one of the possible mechanisms for this condition. The TCR is a well-established neurogenic reflex which manifests as bradycardia, hypotension, apnea, and gastric hyper motility. The TCR shares many similarities with the DR which is a significant physiological adaptation to withstand hypoxia during apnea in many animal species including humans in clinical manifestation and mechanism of action. The DR is characterized by breath-holding (apnea), bradycardia and vasoconstriction leading to rising in blood pressure. Several studies have described congenital anomalies of autonomic nervous system in the pathogenesis of SIDS such as hypoplasia, delayed neuronal maturation or decreased neuronal density of arcuate nucleus, hypoplasia and neuronal immaturity of the hypoglossal nucleus. The abnormalities of autonomic nervous system in SIDS may explain the role of TCR in this syndrome involving sympathetic and parasympathetic nervous system. We reviewed the available literature to identify the role of TCR in the etiopathogenesis of SIDS and the pathways and cellular mechanism involved in it. This synthesis will help to update our knowledge and improve our understanding about this mysterious, yet common condition and will open the door for further research in this field

Maffucci syndrome: Anaesthetic management and review of literature

Maffucci syndrome is a rare, nonhereditary disorder manifesting early in life. The syndrome is characterized by presence of multiple hemangiomas and enchondromas mostly affecting the extremities. Haemangiomas are usually cutaneous, but may sometimes be visceral as well. Enchondromas commonly affect the long bones of the extremities. However, other areas including skull, ribs, vertebrae, larynx and trachea may also be involved. The presence of these lesions in the trachea and/or oropharynx may compromise the airway and cause difficulty during tracheal intubation. Complete airway examination and investigation is important to rule out any such lesion in a patient of Maffucci syndrome before planning for general anaesthesia with tracheal intubation