7 research outputs found
Pulmonary artery hypertension in mitral stenosis: Role of right ventricular stroke volume, atrio-ventricular compliance, and pulmonary venous compliance
An Innovative Simple Technique of Blood Conservation in Adult Patients with Tetralogy of Fallot and Severely Raised Hemoglobin
The adult patients of tetralogy of Fallot often present with high hemoglobin levels. High hemoglobin and hematocrit on cardiopulmonary bypass (CPB) are associated with increased hemolysis, plasma free hemoglobin, renal dysfunction or failure, postoperative bleeding, exploration for bleeding, and increased requirement of allogeneic blood and blood products. Despite the presence of high hemoglobin and its association with adverse outcome, blood conservation is rarely practiced in these patients because of the fear of possible hemodynamic instability, and hypoxemic spell. We describe an innovative, simple technique of blood conservation for adult patients of tetralogy of Fallot with severely raised hemoglobin. With this technique, hemoglobin can be normalized on CPB; moreover, there is no fear of hypoxemic spell or hemodynamic instability. Furthermore, the blood conserved is readily available for transfusion in the perioperative period, if needed
Anesthesia and intracranial arteriovenous malformation
Anesthetic management of intracranial arteriovenous malformation (AVM) poses multiple challenges to the anesthesiologist in view of its complex and poorly understood pathophysiology and multiple modalities for its treatment involving different sub-specialties. The diagnosis of AVM is based on clinical presentation as well as radiological investigation. Pregnant patients with intracranial AVM and neonates with vein of Galen malformation may also pose a special challenge and require close attention. Despite technological advancement, reported morbidity or mortality after AVM treatment remains high and largely depends on age of the patient, recruitment of perforating vessels, its size, location in the brain, history of previous bleed and post-treatment hyperemic complication. Anesthetic management includes a thorough preoperative visit with meticulous planning based on different modalities of treatment including anesthesia for radiological investigation. Proper attention should be directed while transporting the patient for the procedure. Protection of the airway, adequate monitoring, and maintaining neurological and cardiovascular stability, and the patient's immobility during the radiological procedures, appreciation and management of various complications that can occur during and after the procedure and meticulous ICU management is essential
Hypoglycemic Effect of Calotropis gigantea Linn. Leaves and Flowers in Streptozotocin-Induced Diabetic Rats
Objectives: To evaluate the hypoglycemic and anti-diabetic activity of chloroform extract of Calotropis gigantea leaves and flowers in normal rats and streptozotocin induced diabetes.Methods: The hypoglycemic activity in normal rats was carried out by treatment using chloroform extract of Calotropis gigantea leaf and flower 10, 20 and 50 mg/kg, orally. The oral glucose tolerance test was carried out by administering glucose (2 g/kg, p.o), to non-diabetic rats treated with leaf and flowers extracts at oral doses 10, 20 and 50 mg/kg, p.o and glibenclamide 10 mg/kg. The serum glucose was then measured at 0, 1.5, 3 and 5 hr after administration of extracts/drug. Streptozotocin-induced diabetic rats were administered the same doses of leaf and flower extracts, and standard drugs glibenclamide was given to the normal rats or 0.5 ml of 5�0Tween-80, for 27 days. The blood sample from all groups collected by retro-orbital puncture on 7, 14, 21 and 27th days after administration of the extracts/drug and used for the estimation of serum glucose levels using the glucose kit.Results: The Calotropis gigantea leaves and flowers extracts were effective in lowering serum glucose levels in normal rats. Improvement in oral glucose tolerance was also registered by treatment with Calotropis gigantean. The administration of leaf and flower extracts to streptozotocin-induced diabetic rats showed a significant reduction in serum glucose levels.Conclusion: It is concluded that chloroform extracts of Calotropis gigantea leaves and flowers have significant anti-diabetic activity
Decompression of superior vena cava during bidirectional Glenn shunt: A simple but risky technique
Anesthesia for awake craniotomy: A retrospective study
Context: Awake craniotomy is increasingly performed the world over. We
share our experience of performing craniotomy awake with our anesthetic
protocol. Aims: To evaluate and analyze the anesthesia records of the
patients who underwent awake craniotomy at our institution. Settings
and Design: University teaching hospital, Retrospective study.
Materials and Methods: We reviewed records of the 42 consecutive
patients who underwent awake craniotomy under conscious sedation using
Fentanyl and Propofol infusion until December 2005. The drugs were
titrated (Bispectral monitoring was used in 16 patients) to facilitate
intermittent intraoperative neurological testing. All patients received
scalp blocks with a mixture of bupivacaine and lignocaine with
adrenaline. Haloperidol and ondansetron were administered in all
patients at induction of anesthesia. Results: All patients completed
the procedure. One patient each needed endotracheal intubation and LMA
for airway control during closure, while another required CPAP
perioperatively because of desaturation to < 80%. There was
significantly decreased use of anesthetics ( P < 0.001) and a trend
towards reduction in complications (e.g. respiratory depression and
deep sedation) ( P >0.05) with the use of BIS as compared to without
BIS. Intraoperative complications were hypertension (19%), tight brain
(14.2%), focal seizure (9.5%) respiratory depression (7.1%), deep
sedation (7.1%), tachycardia (7.1%) and bradycardia. Two patients
desaturated to < 95%. 23.8% patients developed transient
neurological deficits. The most frequent postoperative complications
were PONV (19%) and seizures (16.6%). Conclusions: With the use of
advanced monitoring and newer anesthetics, awake craniotomy is a
relatively safe procedure with an accepted rate of complications