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.

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.

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.

Is CT scan a predictor of instability in recurrent dislocation shoulder?

Purpose: Glenoid bone defect and the defect on the posterior-superior surface of the humerus “Hill- Sachs lesion” are the commonly seen bony lesions in patients with recurrent dislocation shoulder. Computed tomography (CT) scan is considered as the best option in assessing the bony defects in the recurrent dislocation shoulder. The aim of this study was to assess the clinical and radiological corelation in the patients with recurrent dislocation shoulder. Methods: Forty-four patients of recurrent dislocation shoulder who were evaluated between January 2015 and December 2017 at a tertiary care center, clinically and radiologically using CT scan and meeting the inclusion criteria, were included. The correlation between the clinical history of the number of dislocations and the bone loss using CT scan was evaluated. Two sided statistical tests were performed at a significance level of α=0.05. The analysis was conducted using IBM SPSS STATISTICS (version 22.0). Results: All the patients were male with mean age of 25.95 (SD ± 4.2) years were evaluated. Twenty-four patients sustained injury in sporting activities while 20 patients sustained injury in training. There were an average of 4.68 (SD ± 3.1, range 2e15, median 3) episodes of dislocation. Forty-one patients had the glenoid bone loss while 40 had the Hill-Sachs lesions. The mean glenoid width defect was 10.80%(range 0e27%) while the mean Hill-Sachs defect was 14.27 mm (range 0e26.6 mm). The mean area of bone loss of the glenoid surface was 10.81%(range 0e22.4%). The lesions were on track in 34 patients and off track in 10 patients. Conclusions: CT scan of the shoulder joint is an effective method for assessing the amount of bone loss. The number of dislocations are correlated significantly with off-track lesions and the amount of bone loss on the glenoid and Hill-Sachs lesion. The glenoid width bone loss of more than 9.80% or Hill-Sachs defect of more than 14.80 mm are the critical defects after which the frequency of dislocations increases.

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.