Large left ventricular pseudoaneurysm and spontaneous recanalized coronaries

35 year old with ruptured lateral wall of Left ventricle (LV) resulting in large pseudo aneurysm contained within the pericardium [Figure 1]. There was free flow of blood between the LV and pseudoaneurysm .He underwent endoventricular patch plasty of the defect after opening the wall of aneurysm [Figure 2]

Catatonia and jaw dislocation in the postoperative period with epidural morphine

We report a case of temporomandibular joint dislocation occurring in the postoperative period in a patient, who developed catatonia following administration of a single dose of epidural morphine. The catatonic response to epidural morphine was delayed by several hours in the postoperative period, and might have resulted from intrathecal migration of the drug, through an initial dural puncture while locating the epidural space. The temporomandibular joint dislocation was diagnosed only after reversal of the effects of morphine with naloxone, when the patient complained of inability to fully close her mouth

Dose-reversal effect relationship of three different doses of neostigmine in obese patients: A randomised clinical trial

Background and Aims: Previous studies suggest that administration of vecuronium based on total body weight rather than ideal body weight (IBW) in obesity results in overdosing with prolonged recovery times. We hypothesised that larger doses of neostigmine could result in faster recovery in obese patients administered vecuronium based on total body weight. Methods: Forty-five obese American Society of Anesthesiologists' II patients undergoing elective surgery under general anaesthesia were randomised into 3 groups to receive neostigmine 30, 40 and 50 μg/kg. Following induction, patients were paralysed with vecuronium 0.1 mg/kg based on total body weight. Reversal was achieved with neostigmine based on the patient's group, and time to train-of-four (TOF) ratios of 0.5, 0.7 and 0.9 measured. The primary outcome variable was time to achieve TOF ratio >0.9. Results: Neostigmine 50 μg/kg achieved faster recovery to TOF 0.7 than neostigmine 30 and 40 μg/kg. There was no significant difference in recovery times to TOF 0.7 in patients receiving either 30 or 40 μg/kg of neostigmine. However, neostigmine 40 μg/kg attained TOF ratio 0.9 faster than 30 μg/kg. We did not note a significant difference between the 40 and 50 μg/kg dose with regard to recovery of TOF to 0.9. Conclusion: Facilitated recovery from neuromuscular blockade to TOF of 0.7 was faster with neostigmine 50 μg/kg compared to 40 or 30 μg/kg. Recovery to TOF ratio of 0.9 was not significantly different with 40 or 50 μg/kg doses although such time was faster as compared to 30 μg/kg dose

Carbon dioxide rebreathing caused by deformed silicon leaflet in the expiratory unidirectional valve

Rebreathing of carbon dioxide caused by incompetent ′cage and disc′ unidirectional valves has been reported earlier. Some manufacturers have changed the design of unidirectional valves to ′flexible leaflets′. We report a series of cases where a deformed membrane leaflet in expiratory unidirectional valves led to rebreathing of carbon dioxide