Anesthetic consideration in Meigs syndrome with large pleural effusion and lung collapse

Meigs syndrome(MS)is characterized by a benign ovarian tumor(fibroma),hydrothorax on the right side,and ascites;which can be resolved permanently after surgery.Available literature reveals that most MS surgeries were performed under general anesthesia(GA)[1].However,GA poses major risks to the patient.Considering the high risk of gastric content regurgitation,poor general condition or dyselectrolytemia may lead to delayed arousal,and associated multi-organ dysfunction.Intraoperative mechanical ventilation is also difficult due to ascites and hydrothorax(reduced cardiac output,impaired ventilation-perfusion in lungs causing hypoxia and hypercapnia)[1,2].In this letter,we report a case of MS tumor resection under the subarachnoid block(SAB)to mitigate these issues and also review the complications associated with both techniques.

Penetrating soft palate injury by lollypop candy stick

Incidents of soft palate injury or laceration caused by unintended movement when holding a sharp object in the mouth in the pediatric population are usually rarely reported.Here we report a case of soft palate laceration in a child due to a lollypop stick tip.

Efficacy of propofol versus ketamine in modified electroconvulsive therapy: A prospective randomized control trial

Objective:To investigate the effects of propofol and ketamine on seizure duration,hemodynamics,and recovery of electroconvulsive therapy(ECT).Methods:This prospective randomized trial included patients who had undergone ECT under anesthesia.Patients received injection of propofol 1.5 mg/kg i.v.(the propofol group)or ketamine 0.8-1.2 mg/kg i.v.(the ketamine group)during ECT.Seizure duration,hemodynamics,and recovery were recorded and compared between the two groups.Results:This trial included 44 patinets with 22 patients receiving propofol and 22 patients receiving ketamine.The total dose of propofol and ketamine was(105.68±25.27)mg and(81.36±24.55)mg,respectively.The motor seizure and electroencephalogram seizure duration were prolonged in the ketamine group(P<0.001).The hemodynamics at the admission of the two groups were comparable(P>0.05);however,the mean systolic blood pressure during the procedure was significantly higher in the ketamine group(P=0.04).Besides,spontaneous eye-opening in the ketamine group took longer than that of the propofol group(P=0.001).Conclusion:Both propofol and ketamine are safe as anesthetic agents for modified ECT,and ketamine provides a longer seizure duration without hemodynamic instability or any significant complication.

Dengue fever leading to acute dengue hemorrhagic leukoencephalitis:A case report

Rationale:Dengue fever is a prevalent tropical infectious disease that has a broad panorama of presentations from mild febrile illness to life-threatening manifestations in the form of dengue hemorrhagic fever and dengue shock syndrome.Patient’s concerns:A 20-year-old male presented with a 2-day history of fever,multiple episodes of vomiting,and altered sensorium.Diagnosis:Dengue fever leading to acute hemorrhagic leukoencephalitis.Interventions:Multiple transfusions of single donor platelets,intravenous methylprednisolone,intravenous immunoglobulin,anti-seizure prophylaxis,and broad-spectrum antibiotics.Outcomes:Repeat brain magnetic resonance imaging showed resolution of lesions.The patient was subsequently discharged from the hospital in a healthy state.Lessons:This report helps us to gain a better understanding of the patient’s presentation,which will help to improve the timely recognition and prevention of this rare devastating presentation.

Comparative study on effects of dexmedetomidine and dexamethasone on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic surgery

Objective:To compare the safety and efficacy of dexmedetomidine and dexamethasone for the prevention of postoperative nausea and vomiting(PONV)in patients scheduled for laparoscopic surgery.Methods:A total of 86 female patients were prospectively administered dexmedetomidine 1μg/kg i.v.(the group A,n=43),and dexamethasone 8 mg i.v.(the group B,n=43).The two groups were compared in treatment response,hemodynamic changes,and Numerical Analog Scale(NAS).Besides,the relation of PONV with patient baseline characteristics in the perioperative period was determined as well.Results:Patients in group A had lower PONV scores(t=3.1,P<0.002),less needs for rescue anti-emetics(χ2=0.47,P<0.001),and decreased intraoperative heart rate(t=9.72,P<0.001)and mean arterial pressure(t=7.58,P<0.001)compared to that of group B.Group A reported lower NAS than group B(t=2.66,P<0.001).In addition,we found no relationship between PONV score and rescue anti-emetic requirement,age,or body mass index(P=0.96,P=0.60,P=0.28,respectively).Conclusion:Dexmedetomidine could be used as an effective antiemetic in laparoscopic surgeries,with better efficacy than dexamethasone.Dexmedetomidine not only can reduce PONV but also is effective in postoperative analgesia.

Resuscitative cardiac arrest during a Caesarean section-When every second counts:A case report

Rationale:Cardiac pulmonary arrest is the most challenging and dreaded complication of neuraxial blockade.Patient’s concern:A 21-year-old patient at 37 weeks of gestation,with previous lower segment Caesarean section pregnancy presented for elective Caesarean section.Diagnosis:Cardiac arrest after performing a subarachnoid block.Intervention:Maternal resuscitation.Outcome:Return of spontaneous circulation was achieved within 4-5 min of cardiopulmonary resuscitation.A single live healthy male baby was delivered.Lesson:A careful preoperative evaluation,adequate preload,constant vigilant monitoring to recognize vasovagal response at the earliest,and immediate initiation of resuscitative measures play the most important role in saving the precious lives in case of pregnant patients undergoing Caesarean section under subarachnoid block.

Tendo-Achilles injury:An observational study in a tertiary care hospital

Objective:To report demographic and injury characteristics of tendo-Achilles(TA)injury,and determine its association with the use of Indian style commode seat(ISCS),the clinical and functional outcomes.Methods:This observational study was conducted between 1 January 2016 and 31 December 2019,and a total of 44 patients with TA injury were included in the study.Their demographic profile,etiology,operative details,and functional outcomes were studied.All patients underwent primary repair followed by standard postoperative management and follow-up for 6 months.Results:Out of 44 patients,7(15.9%)sustained closed injuries while 37(84.1%)sustained open injuries.In open injury cases,30(81%)patients suffered an injury due to slipping in ISCS,4(11%)from road traffic accidents,and 3(8%)due to falling of a heavy object.Besides,20.45%of cases of ISCS injury had associated neurovascular injury.Twenty(45%)patients took more than 90 days to start independent ambulation.At 6 months follow-up,no one could reach pre-injury fitness status.Conclusions:Open TA injury by ISCS is an important,under-reported,and preventable cause of loss of physically active manpower in institutional setups.

A rare fatal case of rabies coexisting with COVID-19

Rabies is a zoonotic disease that affects the central nervous system(CNS)of humans with an extremely high mortality rate.This disease is transmitted to humans through the bite of rabid animals,usually dogs.Post-exposure prophylaxis(PEP)is recommended for all rabid animal bites.If delayed or missed there is a very high chance of developing the disease which is almost always fatal.About 55000 human rabies-related deaths are reported due to delayed or deferred rabies PEP in the world annually[1].The public usually ignores earlier indicators of rabies and is unwilling to consult a doctor,to avoid contracting COVID-19 during hospital visit[2].We present a case of human rabies infection due to non-compliant PEP amid the COVID-19 pandemic following a rabid dog bite.

Similar functional outcome using single anterior portal and standard two portals technique in recurrent dislocation of shoulder

Purpose:Recurrent dislocation of shoulder(RDS)is a common injury in high demand professionals,like athletes and military personnel.The treatment for the patients with Bankart lesion is the arthroscopic repair.This present study compares the outcomes of two different techniques of arthroscopic Bankart repair i.e.a standard two anterior portals technique and a single anterior portal technique in patients with RDS.Methods:Patients with traumatic RDS met the inclusion criteria were managed with Bankart repair using either two anterior portals(Group A)or a single anterior portal(Group B)technique.Patients were evaluated before the intervention and at the mean follow-up of approximately two years using Rowe score,Oxford shoulder score and Tegner activity scale.Results:The mean age of the patients in Groups A(n=34)and B(n=37)was 29.64 years and 29.05 years respectively(p=0.66).The dominant shoulder was involved in 27 patients in Group A and 22 patients in Group B(p=0.069).The operative time in Group A and B was 68.52 min and 46.35 min,respectively(p<0.001).The complications at follow-up,the mean Rowe score and Oxford score improved significantly in both groups compared with the pre-operative values.However,the final outcome scores were not significantly different between the both groups.The median Tegner's score preoperatively and at follow-up was 7 and 6,respectively in Groups A and B.Conclusions:Single anterior portal technique is an effective treatment modality,yielding a similar outcome as two anterior portals technique in the management of RDS.