Airway management of post burn contracture neck – An anaesthesiologist's challenge

AbstractAirway management is a challenge to anaesthesiologist owing to fixed flexion deformity resulting in nonalignment of oral, pharyngeal and laryngeal planes for intubations. The Ovassapian fibreoptic intubating airway, Williams airway intubator and the Berman oropharyngeal airway may provide a conduit for the bronchoscope. We present the successful anaesthetic management of a patient with obliteration of nasal passages, microstomia and severely limited neck extension by awake oral fibreoptic intubation aided by Berman's airway

Emergency Surgery in a Patient with Scleroderma - Anaesthetic Challenges: A Case Report

Scleroderma (progressive systemic sclerosis) is a multisystem disease involving the skin, airway, musculoskeletal, gastrointestinal, pulmonary, renal and cardiac systems that can pose a significant challenge for the anaesthetist. The multisystem involvement of scleroderma can impact on every aspect of anaesthetic care especially airway management. There are no specific contraindications to the use of any type of anaesthesia, although the selection must be guided by identification of organ dysfunction. The anaesthetist must be aware of the organs involved, the severity of the disease and the associated anaesthetic considerations and potential risks in order to safely & skilfully manage the patient with scleroderma. We hereby present a case report of a patient with scleroderma for emergency orbital decompression because of orbital cellulitis

Anaesthetic Considerations in a Patient with Deep Vein Thrombosis on Warfarin for Emergency Surgery - A Case Report

Anaesthesiologists very often face the challenging task of providing anaesthesia to patients on oral anticoagulant therapy, for elective and emergency surgeries. Rapid reversal of anticoagulation for emergency surgery can be achieved by replacement of coagulation factors with fresh frozen plasma or prothrombin complex concentrate and simultaneous administration of vitamin K for sustained reversal. The present case report of a 26 year female, on warfarin for thromboprophylaxis, scheduled for laparotomy, is followed by a brief discussion on anticoagulation reversal and anaesthesia

Apert syndrome: Anaesthetic concerns and challenges

Apert syndrome is a congenital autosomal dominant disease characterized by brachycephaly, craniosynotosis, midface hypoplasia, hypertelorism, choanal stenosis, multidigit hand and foot syndactyly. Anaesthetic management of a child with Apert syndrome poses a great challenge to anaesthesiologist. The child should be evaluated thoroughly by history, examination and investigations for associated anamolies and managed accordingly. There is no definite recommendation for general or regional anaesthesia and also there are no known contraindications to specific anaesthetic agent and drug. However, whenever possible, regional anaesthesia should be preferred as the incidence of obstructive sleep apnoea is high in these patients. If general anaesthesia is planned, difficult airway cart should be kept ready. Temperature monitoring should be done intraoperatively and the patient should be monitored postoperatively for signs of airway obstruction

Anaesthetic management of a case of schwannoma with intraoral extension

Schwannoma is a benign nerve sheath tumour. This benign lesion frequently occurs in the soft tissues of head and neck region and has various complicated growth patterns. These patients can present a challenge to the anaesthesiologist due to intraoral extension, leading to difficult mask ventilation and intubation. We report a 16 year old male with mandibular nerve schwannoma with intraoral extension. Intraoral examination revealed a diffuse swelling in the left side of soft palate with deviation of uvula to right side. He was advised gargles with 4 ml of 2% xylocaine viscous and 2–3 puffs of 10% xylocaine spray done in oral cavity and oropharynx. Check laryngoscopy revealed Cormack and Lehane grade 1 view. Patient was intubated using standard induction technique and successfully manage