Indian Journal of Anesthesia and Analgesia

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This short communication was aimed at re-exploring the evidence contribution provided by systematic reviews and meta-analyses on pain in diabetic peripheral neuropathy (DPN) in order to provide implications for anesthetic and analgesic management. Existing evidence though limited provide sufficient information on epidemiology of DPN with prevalence rates ranging between 26-47%;annual pain medication costs of $1,004 per DPN patient;duloxetine, gabapentin, alpha lipoic acid and pregabalin were effective drugs; and consensus guidelines recommended that choice for treatment must also include consideration of adverse effects, individual patient factors such as comorbidities, and often cost.          

                                                                                                                                                Keywords: Levels of evidence; Diabetic neuropathy; Neuropathic pain; Evidence-informed pain management; Neuroanesthesiology.

We report a case of an adult male patient with end stage renal disease having a congenital ventricular septal defect (VSD) who underwent renal transplant. The procedure was carried out under central neuraxial block- combined sub arachnoid and epidural block. Perioperative period was uneventful with good postoperative graft functioning.    

Keywords: Central neuraxial blockade; Renal transplant; Venticular septal  defect.

Anesthetic management of necrotizing fasciitis of neck associated with Ludwig’s angina is presented. This case was challenging as all the major vessels and tracheal rings were visible from outside. Also because of massive blood loss patient was in hypovolemic shock. Necrotizing fasciitis is a rare, rapidly progressive, life threatening infection process primarily involving the subcutaneous tissue and fascia with thrombosis of the subcutaneous blood vessels. While Ludwig’s angina is a serious, potentially life-threatening infection of floor of the mouth and neck. This condition is notorious for its aggressiveness, rapid progression to airway compromise and high mortality when not treated promptly. These conditions cause severe threat to the patient’s life.

Keywords: Necrotizing fasciitis; Ludwig’s angina; Hypovolemic shock.