Exploring anesthesiologist niche in burn management: Putting the tube where it belongs. A case series on difficult airways in burns

Burn injuries are complex and challenging, requiring a multidisciplinary approach. We have done more than 15 cases of severely distorted airways in patients with burns (photos attached); although the basic case management remains the same, there are a plethora of other concerns that make these patients unique. The most unique and severe 11 cases we have discussed assiduously. Out of all the concerns, airway management remains the most challenging one. Timely intervention and keen vigilance are required to prevent a disaster later on

A case of ostium secundum atrial septal defect for major decompressive spine surgery – covering the paths still left untreaded

Atrial septal defect (ASD) accounts for 35% of all congenital heart diseases in adults. Patients usually present in their twenties or thirties owing to gradually progressive right ventricular remodeling because of left to right shunt, right-sided heart failure, and pulmonary hypertension. In this case report, we present the management of young female patient with ASD posted for D5 spine decompression and fixation. Patients with congenital heart disease for spine surgery present with unique set of challenges for anesthesiologists. Well-prepared anesthesia plan is essential to prevent increase in shunt fraction, shunt reversal, hypoxia, hypercapnia, acidosis, and hypothermia along with careful addressal of positioning issues to ensure smooth recovery of patient

External oblique intercostal block in open nephrectomy patients - A zenith in analgesia for anterolateral upper abdominal surgeries: A case series

Open nephrectomy is a common surgery usually performed for malignant and non-malignant renal pathologies. The external oblique intercostal block (EOIB) blocks the anterior and lateral cutaneous nerves from T6 to T10 and provides somatic analgesia. We present a case series of the use of EOIB in patients undergoing open nephrectomy by subcostal incision. Ten patients were given EOIB, which included patients undergoing simple nephrectomy for non-functioning kidneys and radical nephrectomy for renal mass. The patients had satisfactory numerical rating scale scores, mostly <4 for 24 h. Post-operative opioid consumption was minimal. The external oblique fascial plain block is a novel thoracic block that provides reliable upper thoracoabdominal somatic analgesia. It can certainly be considered a suitable option in surgeries such as nephrectomies that involve an upper lateral abdominal wall incision

Novel triple injection technique - Avante garde for costoclavicular block. A Case series

Costoclavicular block has garnered the attention of regional anesthesia enthusiasts because the cords are snuggly packed and consistently arranged in a particular pattern around the first part of the axillary artery. The single injection technique has been widely used conventionally, but the effect is unpredictable. The effect is unpredictable because of the septum that compartmentalizes cords in upper and lower compartments. We propose a triple injection technique targeting the individual cords separately. Onset time of sensory block from 16 min to 7 min. The average time for a complete motor block was 9.6 min. The chances of the median nerve sparing, as has been reported in some cases in previous studies, are almost nil by this technique–the corner pocket injection that involves the medial root of the median nerve and the lateral cord that is specifically blocked separately, covering the lateral root of the median nerve. The costoclavicular block has already carved a niche as an excellent choice for surgeries of the upper limb involving the elbow or below the elbow. The use of the triple injection technique makes the block effect more predictable and reliable

Temporomandibular joint ankylosis - An anesthesiologist’s nightmare: Case series

Temporomandibular joint (TMJ) ankylosis is defined as bony or fibrous adhesion of the anatomic joint components accompanied by a limitation in opening the mouth. Airway management is a grueling task and has confronted anesthesiologists ever since. The challenge is even more exaggerated when it is a pediatric patient. We present a case series of five pediatric patients with TMJ ankylosis with age 7 years or less, who were posted for its corrective surgery. Although all patients belonged to the pediatric age group, the challenges faced and techniques employed to overcome them were different partly because of different age groups and partly the nature of the airway, with tailoring of each technique accordingly. Pediatric airway management is no less than waging a war as all necessary skills and expertise are put to the test. It combines fortuity with skills. We have to be prepared for the worst in any unforeseen scenario