Anesthetic challenges for pheochromocytoma surgery in pediatric patients: A case series

Pheochromocytoma in children is an exceptionally uncommon cause of hypertension in this age group. These tumors pose a significant threat of adverse cardiovascular events during the perioperative phase. In this article, we describe three cases of pediatric pheochromocytoma to shed light on the difficulties associated with administering anesthesia to patients with this condition. The foundations for successful perioperative outcomes include preoperative blood pressure control, extensive intraoperative hemodynamic evaluation, and appropriate coordination with surgeons

Unexplained anasarca in type 1 diabetes mellitus: Breaking the hypoalbuminemia – Persistent diarrhea cycle

Background: Undiagnosed Type 1 diabetes mellitus (T1DM) often presents as diabetic ketoacidosis (DKA). We report a child with newly diagnosed T1DM who developed anasarca and persistent diarrhea following resolution of DKA and was referred to us for the same. Clinical Description: We reviewed the clinical history, examination, and investigations that had been undertaken. Our clinical evaluation was in concurrence with the referring hospital-anasarca with probable partially treated spontaneous bacterial peritonitis (SBP). However, the cause of the subacute anasarca and persistent diarrhea was unclear. The child was empirically started on broad-spectrum antibiotics for the SBP, a high-protein diet to build up the protein, and continued the same subcutaneous insulin, on which he was euglycemic. After ruling out usual causes, i.e., renal, hepatic, and cardiac, we reviewed the possibility of celiac disease, tuberculosis, insulin edema, and hypothyroidism. Management: When he did not improve despite a good appetite, adherence to management, and all tests were inconclusive, we reviewed the etiopathogenesis. Untreated T1DM had led to chronic negative catabolism that had precipitated severe hypoproteinemia. A vicious cycle had set in which hypoalbuminemia was leading to bowel wall edema, resulting in protein malabsorption, perpetuation of diarrhea, and further hypoproteinemia. Our assumption proved to be correct when a single dose of parenteral albumin broke the cycle, and the child improved drastically with the resolution of diarrhea within 24 h and the edema in a few days. Conclusions: This case highlights the implications of severe catabolism in a patient with untreated diabetes and how this may be a self-perpetuating condition

Hypoparathyroidism precipitated by mumps: An unusual temporal association

Background: Hypoparathyroidism is a condition characterized by hypocalcemia and hyperphosphatemia due to insufficient secretion of parathyroid hormone (PTH). The common causes of hypoparathyroidism are postsurgical and autoimmune. We describe a case of hypoparathyroidism precipitated by mumps. Clinical Description: A 17-year-old boy was brought to us with altered sensorium following 2 episodes of generalized tonic-clonic seizures within the last 4 h. He required mechanical ventilation, but severe laryngospasm made intubation difficult. He had been suffering from a febrile illness that appeared to be mumps for the preceding 4 days. The only salient biochemical abnormality was hypocalcemia and hyperphosphatemia. Neuroimaging and cerebrospinal fluid examination were normal. Hypoparathyroidism was suspected and confirmed by low PTH levels. He also developed secondary hypothyroidism. Management and Outcome: The child had no symptoms of hypocalcemia in the past. He was started on intravenous calcium and calcitriol. He showed dramatic improvement in sensorium with normalization of serum calcium levels. He was extubated after a week. At discharge, there were no neurological sequelae and the sick euthyroid syndrome had resolved. Viral serology for mumps was reactive by the 3rd week of illness. Conclusion: Although viral infections have been described as triggers for other endocrinopathies, we could not find any association with hypoparathyroidism. An exhaustive literature search we could not find any similar case reports of hypoparathyroidism during or following mumps. Whether mumps infection had any role in the pathogenesis of the hypoparathyroidism or only unmasked an underlying endocrinopathy remains uncertain

Nasogastric tube insertion using conventional versus bubble technique for its confirmation in anesthetized patients: a prospective randomized study

Background: Nasogastric tube insertion and confirmation of its position can be difficult in the anesthetized patient. The purpose of the present study was to compare the bubble technique with the conventional method for confirmation of nasogastric tube placement in these patients. Methods: Two hundred sixty adult patients, aged between 20...70 years, posted for surgeries requiring general anesthesia, tracheal intubation, and a nasogastric tube were enrolled in this study. Patients were randomized into 2 groups: Group B (Bubble group) and Group C (Control group). In Group C, a conventional technique using a lubricated nasogastric tube was positioned through the nostril with head remained neutral. In Group B, 2% lidocaine jelly was added to the proximal end to form a single bubble. The correct placement of the nasogastric tube in the stomach was confirmed by fluoroscopy by an independent observer intraoperatively. Results: The duration of nasogastric tube insertion was 57.2 .. 13.3 seconds in Group B and 59.8 .. 11.9 seconds in Group C (p = 0.111). The confirmation rate of the bubble technique was 76.8% (95% CI: 68.7...83.3), which was significantly better than the conventional method where the confirmation rate was 59.7% (95% CI 50.9...67.9), p < 0.001. When compared to fluoroscopy, bubble technique was found to have a sensitivity of 92.3% (95% CI: 85.6...96.1) with specificity of 81.0% (95% CI: 60.0...92.3), positive predictive value of 96.0% (95% CI: 90.2...98.4), and a moderate negative predictive value of 68.0% (95% CI: 48.4...82.8). Conclusions: The bubble technique of nasogastric tube insertion has a higher confirmation rate in comparison to the conventional technique. Trial Registry Number: Clinical Trial Registry of India (CTRI/2018/09/015864)

Is maternal anemia among tribal women being neglected? A study from Southern Rajasthan

Poor birth outcomes have been linked to maternal anemia. Tribal women are at higher risk of malnutrition and disease due to sociocultural barriers and poor educational status. The data on the prevalence of maternal anemia and its associated factors among pregnant tribal women are limited. A community-based cross-sectional study was conducted among 429 pregnant tribal women for maternal anemia from August 2021 to June 2022. A structured questionnaire was employed to collect sociodemographic data. The prevalence of anemia was 85.7%, with a mean hemoglobin level of 9.21 ± 1.3 g/dL. On applying WHO 2011 anemia criteria for pregnant women, 25.0% had mild anemia, 73.4% had moderate anemia, and 1.6% had severe anemia. The significant factors associated with anemic condition were household condition, monthly income, and husband's occupation. The higher prevalence of anemia among pregnant tribal women is alarming that necessitates a rethinking of health infrastructure and outreach in tribal dominant areas

Difficult intubation in a patient with carcinoma colon due to tracheobronchopathia osteochondroplastica: An incidental finding or otherwise

Purpose: Tracheobronchopathia osteochondroplastica (TO) also known as tracheopathia chondro-osteoplastica, is a rare benign chronic disease of undetermined etiology usually involving the trachea and bronchi. We describe the case of a 40-year-old male with carcinoma colon with difficult intubation who was later diagnosed to have TO. Previously also TO has been reported with carcinoma colon. Whether this is an incidental finding or the two have any correlation remains to be deciphered. Clinical features: The patient had no previous symptoms despite the presence of extensive endotracheal lesions. The patient had to be intubated with a tube that was several sizes smaller for his height and weight. Subsequent intraoperative and postoperative period was uneventful. The diagnosis of TO was confirmed by subsequent radiological and histopathological examination. Conclusion: Awareness of this entity and its anticipation in patients with colorectal carcinoma may help anesthetists to manage similar cases appropriately in the future. Also it shall help in future research being directed to this condition