Anaesthetic challenges in a paediatric patient with escobar syndrome-difficult airway and postoperative pneumothorax

Escobar syndrome (ES) is an autosomal recessive disorder characterised by the presence of pterygia in cervical, antecubital and popliteal regions. Anaesthesiologist encounter notable challenges in this syndrome, especially airway management due to associated malformations like cleft lip/ palate, micrognathia, syngnathia, ankyloglossia, neck contracture, cervical spine fusion, limited neck extension and craniofacial dysmorphism. In addition to difficult airway, anaesthesiologist may encounter other perioperative challenges. Here, we report a paediatric patient with ES, who required general anaesthesia for laparoscopic inguinal hernia repair and orchidopexy. Initial attempt with video laryngoscope failed due to inability to visualise epiglottis. Subsequent attempt with fibreoptic bronchoscope also failed due to rapid decrease in oxygen saturation. He was finally intubated with fibreoptic bronchoscope along with oxygen insufflation with a 3mm internal diameter polyvinylchloride endotracheal tube inserted nasally and connected to oxygen supply. Further perioperative challenges faced were intraoperative hyperthermia and postoperative pneumothorax with mediastinal shift. To the best of our knowledge, this is the first case reporting pneumothorax with mediastinal shift as a postoperative complication and use of oxygen insufflation through nasal tube during fibreoptic intubation in paediatric patient with ES

Perioperative hypertensive response in a patient with implanted deep brain stimulation device: a case report

This case report features unique anaesthetic management of a patient with implanted deep brain stimulation (DBS) device undergoing abdominal surgery. It features the intraoperative measures taken for this patient for the implanted DBS. After turning off the DBS preoperatively, the patient showed an exaggerated sympathetic response which was very much resistant to medicines. It was unique to this patient that restarting the device alleviated refractory hypertension. The report also includes review of literature for anaesthetic management of patients with implanted DBS. Keywords: Deep brain stimulation, Dystonia, Hypertension, Hysterectomy

Prevalence of Respiratory Complications In Covid-19 Patients

Background & Objective: In 2019 COVID-19 virus was emerged from China which was then declared a pandemic by WHO. This virus affects different organs of the body and causes some serious complications mainly affecting the respiratory system. The main objective of this research was to find out the prevalence of respiratory complications in patients with COVID-19. Methodology: A cross-sectional survey was conducted on patients with COVID-19 to find out the prevalence of respiratory complications in people. A sample size of 200 participants was selected using the non-probability convenience technique. The duration of the study was 6 months i.e., April to September 2021. Data was collected from Public sector hospitals situated in Rawalpindi and Islamabad in the form of hard copies. The tools used for the data collection were the CAP scale, MMRC scale for dyspnea, and CAT scale. The collected data was analyzed using SPSS Statistics V23.0. Results: Out of 200 participants, 111(55.5%) were male and 89 (44.5%) were females. The mean values of Community-acquired pneumonia (CAP) scale, Modified Medical Research Council (MMRC) scale for dyspnea and COPD Assessment Test (CAT) scale are 48.3, 3.02 and 26.09. Out of 200 participants Dyspnea was prevalent in 77.5% of people, Pneumonia was prevalent in 68% of people and COPD was prevalent in 56% of people. The P value for the three groups including CAP, MMRC and CAT is less than 0.05 (P < 0.05) which indicates that results are statistically significant. Conclusion: The findings indicate that there is a prevalence of Respiratory complications in COVID-19 Patients. Results are statistically significant as P value is P < 0.0