Paravertebral and Brachial plexus block for Abdominal flap to cover the upper limb wound

We present a case report where thoracic paravertebral block and brachial plexus block were used in a sick elderly patient with poor cardiopulmonary reserve, to cover a post traumatic raw area of the upper limb by raising flap from lateral abdominal wall. The residual raw area of abdomen was then covered with the split skin graft taken from thigh

A study to compare caudal levobupivacaine, tramadol and a combination of both in paediatric inguinal hernia surgeries

Background and Aims: Caudal block is a safe and simple method of pain relief in young children with the drawback of a short duration of analgesia which can be overcome by adding various adjuvants to the injected local anaesthetic. We compared the effects of caudal levobupivacaine, tramadol and a combination of both in paediatric patients undergoing inguinal herniotomy. Methods: A total of 78 children aged 1–7 years, planned for inguinal herniotomy were randomly allocated into three groups. Group L received levobupivacaine 0.125% 1 ml/kg, Group T received tramadol 1.5 mg/kg in 0.9% NS and Group LT 1 ml/kg of 0.125% levobupivacaine with 1.5 mg/kg tramadol caudally. The primary outcome was the duration of analgesia. Rescue analgesic doses required, the duration of motor blockade and adverse effects were recorded for 12 h post-operatively. Data was analysed by analysis of variance test, Kruskal-Wallis and Chi-square tests. Results: All groups were comparable with regard to age, sex and duration of surgery. No motor block was observed in any of the patients. The mean duration of analgesia in Group L was 321.46 ± 84.76 min, in Group T was 565.19 ± 107.08 min, and in Group LT was 720 min (P < 0.001). The requirement for rescue analgesia in tramadol group was significantly less as compared to levobupivacaine group. Sedation scores and adverse effects were comparable among all groups. Conclusion: Addition of tramadol to caudal levobupivacaine significantly increased the duration of postoperative analgesia

Ultrasound measurement of subglottic diameter for determination of microcuff endotracheal tube size and intubation outcome in paediatric cases: An observational study

Introduction: One of the biggest achievements of medical science is safe anaesthesia especially for children. Management of airway takes priority over any other intraoperative intervention during anaesthesia .Determination of “best -fit” endotracheal tube (ETT) is important in children to provide optimum ventilation without causing any laryngotracheal morbidity[1-4]. Aim: To investigate the 1st attempt success rate of intubation using best fit Micro cuff ETT ( MCETT) size, determined by ultrasound measured subglottic diameter in paediatric population and to compare the result with age based size table of micro cuff endotracheal tube. Materials and methods: 66 paediatric patients aged between 1‑10 year, undergoing various elective surgeries under general anaesthesia were included in the study .The subglottic airway transverse diameter was measured in the brightness (B) mode using the linear probe (range 6-13 MHz) of the USG device with the child in the supine and neutral head position. Best-fit tube ID is considered as the one with satisfactory air leak at an airway pressure of 15-20cm H2O. 1st attempt success rate of intubation using best fit MCETT size, determined by ultrasound measured subglottic diameter in paediatric population were compared with the result with age based size table of micro cuff endotracheal tube. Results and Conclusion: Comparisons of means of sizes of correct MCETT with age based table and with USG guided method revealed that both methods are good predictors for the correct MCETT size estimation (p-value&lt;0.05). However, size of correct MCETT matched with MCETT size calculated using USG method was in 56 patients (84.8%), whereas the MCETT by age-based table selected the correct tracheal tube size in 42 (63.6%) patients with the difference being statistically significant (p=0.026). Furthermore, reliability agreement calculated by Intraclass correlation coefficient suggested that USG based methods are better than age based formulas in children with k- values of 0.939 and 0.887 respectively. Conclusion: We conclude that ultrasound appears to be a reliable predictor for the assessment of the subglottic diameter of the airway in children to estimate the appropriate size of microcuff endotracheal tube

Survival in esophageal atresia diagnosed on 19th day of life: Lessons learned

Delayed diagnosis of esophageal atresia (EA) is associated with bad prognosis. Only five cases of survival with delayed presentation in the 3rd week of life have been previously reported. We present a rare case of survival in a neonate, who presented on the 19th day of life with regurgitation of feed and respiratory distress. After preoperative optimization, primary repair was performed the next day. The use of number 10 sterile, blunt-tipped, soft-red rubber catheter to rule out EA shortly after the birth in the delivery (resuscitation) room by attending doctor or trained paramedical personnel is recommended

Challenges and outcomes of pregnancy in an uncorrected Tetralogy of Fallot with pulmonary atresia and major aorta-pulmonary collateral arteries (MAPCA): a case report

Abstract Background Tetralogy of Fallot is a severe type of congenital heart disease (CHD) and one of the leading indirect causes of mortality & morbidity among women with CHD. We came across a rare case of an uncorrected Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries in pregnancy. Case presentation We are reporting the challenges in managing a pregnancy of 25-years-old G3 P0110, previous one stillbirth and who was diagnosed to have congenital heart disease during pregnancy following spontaneous abortion. Conclusions This case report highlights the role of multidisciplinary care in managing such a high risk case. It also emphasizes the role of cardiac examination of every woman before pregnancy so that definitive treatment or optimization can be done in time for a better outcome