Perioperative management of geriatric patients for orthopedic surgeries

With increasing life expectancy, the mean age of patient orthopedicians and anesthesiologists have to deal with is increasing. In this review article, we discuss the case management of three centurions aged 110, 105 and 102 years respectively who underwent lower limb orthopedic surgery under nerve block, general anesthesia and neuraxial blockade, and elaborate on the various issues faced perioperatively by the treating team. The challenges and differences faced in perioperative period in geriatric anesthesia were discussed and literature reviewed for the benefit of the operating surgeons

Anesthetic management for emergency caesarean section and craniotomy together: an overview of the challenge

Traumatic brain injury in a pregnant woman is a challenge for anaesthesiologist, surgeon as well as paediatrician as it involves care and management of two lives together. We hereby discuss anaesthetic management of a 23 year old pregnant woman with extra axial bleed and brain contusion and skull fracture. Since the fetus was viable without signs of fetal distress, decision of doing caesarean section followed by craniotomy was taken and our patient was discharged a week later and the baby was handed over to attendant the next day

Physicochemical Characterisation of Commercially Available Prussian Blue Insoluble Samples and Its Comparison with Radiogardase Cs

The physicochemical properties of insoluble Prussian blue (PB) play an important role in its thallium binding ability. Therefore, the present study aimed to characterise various physicochemical parameters of PB available commercially and compare them with the USFDA-approved Radiogardase ® -Cs. In addition, PB was synthesised by indirect and direct methods. PB samples and Radiogardase®-Cs were analysed for various parameters like particle size, moisture content, and thermogravimetric analysis (TGA) and correlated with its Maximum Binding Capacity (MBC) for thallium. Radiogardase ® -Cs showed the highest MBC of 238 mg/g for thallium with D 90 of 785 μm and moisture content of 23.24 %. The MBC of other PB samples was found to be significantly lower than Radiogardase ® -Cs which was found to be directly proportional to the moisture content. However, other parameters like particle size, and iron content vary significantly but no correlation was observed with MBC for thallium. This finding suggests that moisture content and MBC are extremely important parameters for optimising the PB to achieve desirable pharmacological efficacy for removing thallium in vivo

A clinical comparative study of ropivacaine versus ropivacaine with fentanyl by continuous epidural infusion for post-operative analgesia and ambulation in patients undergoing major gynecological surgery

Background: To compare the effect of continuous epidural infusion of ropivacaine versus ropivacaine-fentanyl for post-operative analgesia and ambulation in patients undergoing major gynaecological surgeries.Methods: A total of 60 patients of age 20 to 50 yrs of body mass index (BMI) within normal range (18.5to24.9 kg/m2) posted for major gynecological surgeries were divided into two equal groups (Group R and RF) in a prospective, randomized, double-blind fashion. In Group RF (n=30) 0.1% Ropivacaine with 2µg/ml Fentanyl and in Group R (n =30) 0.1% ropivacaine were used. General anaesthesia was given to all patients. Continuous epidural infusion using elastomeric pump was started at ‘0’ post-operative hours at 6ml/hour. Post -operative pain (Visual Analogue Scale Score), ambulation (James Modified Bromage Scale) and side effects were noted at 0, 2, 4, 6, 12, 18, 24, 36 and 48hrs.Results: The differences in VAS Score of subjects of both the groups were statistically significant(p<0.05) at 18 hrs, 24hrs, 36hrs and 48 hrs and the differences in Modified Bromage Scale of subjects of the groups were statistically similar at most of the time intervals. Also, the side effects were statistically similar between the groups.Conclusions: Author concluded that ropivacaine-fentanyl is better than ropivacaine alone by continuous epidural infusion for post-operative analgesia in major gynecological surgeries with no statistically significant side effects, effect on ambulation being similar in both the groups

Prevalence of menopausal symptoms among postmenopausal women of urban Belagavi, Karnataka

BACKGROUND: According to the World Health Organization (1981), natural menopause is defined as no menses for 12 consecutive months with no obvious intervening cause. During the menopause, women may experience vasomotor, psychosocial, physical, as well as sexual dysfunction. Studies on menopausal issues and health demand priority in Indian scenario due to the growing population of menopausal women as a result of their increased life expectancy. OBJECTIVE: To know the prevalence of menopausal symptoms in the postmenopausal women aged 40–60 years. METHODOLOGY: A community-based cross-sectional study was conducted between January 1, 2016, and December 31, 2016, using a predesigned, pretested, structured questionnaire based on sociodemographic variables and menopausal symptoms as per the menopause-specific quality of life questionnaire. A total of 345 postmenopausal women aged 40–60 years residing in the field practice area of Urban Health Centre, Ashok Nagar, Belagavi, were selected by systematic random sampling technique and interviewed during house-to-house visit. The outcomes of this study were menopausal symptoms in the postmenopausal women. Data collected in the questionnaire were coded and entered in Microsoft Excel sheet. Values were expressed in the form of frequency and percentages. Tables were prepared. Statistical significance was set at P ≤ 0.05. RESULTS: In this study, the mean age among study participants was 52.04 ± 5.58 years. Majority 200 (58%) were Hindus, while 266 (77.1%) were literates. The most common menopausal symptoms were of physical domain (75.7%–25.5%), followed by psychosocial domain (63.9%–49.3%) to vasomotor domain (63.5%–55.4%) and least common sexual domain (42.3%–36.2%)

Trifid inferior alveolar nerve - an unusual presentation

[Extract] A 64-year-old male patient, who was otherwise in good health, reported to our department for a routine dental check-up. A screening panoramic radiograph was advised, which incidentally revealed a trifid mandibular canal on the left side of the mandible. To the best of our knowledge, only one earlier reference to this condition has been reported in the literature. 1 In our case, all three branches of the left mandibular canal demonstrated a varied morphology (Figure 1), with the superior branch curving upwards and backwards up to the anterior border of the ramus, the middle branch running anteriorly and acquiring a fusiform shape and fusing with the third branch. The lower most branch could be traced anteriorly up to the mental foramen and had a normal morphology of a single mandibular canal, similar to that on the right side. Figure 2 reveals the traced version of the morphology of the trifid mandibular canal