Airway and esophageal compression from double aortic arch in a case of pentalogy of Fallot: Anesthetic management

Double aortic arch (DAA) is a rare disease requiring high index of clinical suspicion for diagnosis. If undiagnosed, it can pose a serious challenge during anesthetic induction because of dynamic nature of tracheal compression. When DAA is associated with other congenital heart diseases, anesthetic management becomes even more challenging. We report the perioperative anesthetic management of a very rare case of DAA associated with pentalogy of Fallot

GIS-remote sensing-based village-level hydrological balance approach for agricultural water planning

Ensuring food security through the increase in food production can be realised by converting agricultural fallow lands into cultivable ones and assuring irrigations in three crop seasons in all agricultural lands. That can be done through a village (i.e., mouza) level water management planning through rainwater harvesting. This needs step by step procedures based on hydrologic balance for providing the best way of management of water resources to secure precious agricultural lands from man-made degradation. This study was conducted at a mouza Gohalura in the Red and Laterite Zone of West Bengal, India. In that village major crops grown were ‘Aman’ rice (A practices of Rice cultivation by transplanting in rainy season and harvested in early winter season) during the rainy (i.e., monsoon) season; Groundnut during Rabi under both rainfed and irrigated farming situations and ‘Boro’ rice (a practice of rice cultivation by transplanting in late winter and harvesting in early summer) in summer. The major problems in crop production in that village were some rainfed agricultural lands with erratic and uncertain rainfall of which about 26 percent (i.e., 464 mm) received during non-monsoon period (15 October to 7 June), and a high infiltration rate of soil. Shortfall in annual water balance of 248.13 mm could be managed through existing river lift irrigation from the adjoining river Dulung, a tributary of the Subarnarekha River. Application of GIS and remote sensing were useful in land use land cover classification, creation of a digital elevation model of the village and calculation of areas under individual classes of land. Creating and renovating water harvesting ponds in the mouza would facilitate multipurpose benefits for the farming community including agriculture in three crop seasons in all cultivable lands through such rational water management planning in that village. Following such village-wise water balance approach another 16.37 ha (i.e., agricultural fallow out of the total agricultural land area of 40.23 ha) i.e., about 69 per cent increase in irrigated area could be made possible. Such methodologies could be projected for other areas, and that could be followed in other areas also

Anaesthetic Management of A Newborn with Galactosaemia for Congenital Heart Surgery

Galactosaemia is an autosomal recessive metabolic disorder that occurs due to galactose-1-phosphate uridyl transferase enzyme deficiency that leads to hepatic, ophthalmic, neural and renal derangements. Association of cyanotic congenital heart disease with galactosaemia is a rare occurence and a matter of great concern for the anaesthesiologist during open heart surgery. In this case report, the perioperative management of a newborn with galactosaemia operated for correction of transposition of great arteries (TGA) is discussed

Perioperative pentoxifylline therapy attenuates early postoperative neuro-cognitive decline in patients undergoing coronary artery bypass grafting surgery using cardiopulmonary bypass

Background: Postoperative cognitive decline (POCD) after coronary artery bypass grafting (CABG) is a common problem. Studies show that pentoxifylline administration reduces inflammation induced by cardiopulmonary bypass and brain injury after ischaemia. Hence the perioperative use of pentoxifylline in attenuating POCD was evaluated in the study. Materials and Methods: Eighty patients were divided randomly into two groups from 106 patients scheduled for CABG surgery. The study group was administered pentoxifylline 400 mg twice daily orally from day of admission to 7th day after surgery, whereas the control group patients received placebo. Neurocognitive assessment was assessed by an independent clinical psychologist one day after admission to hospital and again on 7th postoperative day. The data was analyzed and a P < 0.05 was considered significant results. Results: Pentoxifylline-treated group showed no statistically significant difference in animal naming test scores (10.3 ± 2.2 versus 9.4 ± 2.5, P = 0.07), digit symbol substitution test (26.1 ± 7.47 vs 22.2 ± 6.07, P = 0.09) and 8 subtests of Post Graduate Institute-memory scale. The control group had significant POCD as detected by animal naming test (10.5 ± 3.7 versus 8.6 ± 3.9, P = 0.008), digit symbol substitution test (20.2 ± 8.2 versus 14.7 ± 8.9, P = 0.008) and five subtests of memory scale (P = 0.01, 0.04, 0.003, 0.005 and 0.02). The incidence of POCD was 50% in placebo-treated group compared to 22.5% in pentoxifylline group. Conclusions: The perioperative use of pentoxifylline attenuates the early postoperative neurocognitive decline after CABG using cardiopulmonary bypass

Alpha blockers: A relook at phenoxybenzamine

Phenoxybenzamine (PBZ) is an alpha adrenergic antagonist, used for the management of hypertension. PBZ acts by blocking alpha-adrenergic receptors, leading to vasodilatation and low systemic vascular resistance. This helps in control of blood pressure in pheochromocytoma, improvement of systemic oxygen delivery, and optimization of the Qp/Qs in pediatric cardiac surgery such as hypoplastic left heart syndrome and improving perfusion parameters during open heart surgery. The uses have further extended to causalgia, Raynaud's phenomenon, autonomic hyperreflexia, and even for patency of radial artery conduit in coronary artery bypass grafting surgery. However, its prolonged hypotensive effect limits the regular use. In this review, we discussed the mechanism of action, pharmaco-physiology of PBZ, perioperative uses in different clinical setting and controversies for its uses; publications in different scientific journals from the previous years