Indian Journal of Anesthesia and Analgesia

Keywords: Evoked Potentials; Cortical Changes; Somatosensory System; Neuroanalgesia. 

 Rare cases in gynecological surgery always pose challenge to anaesthetist. Klipple Feil Syndrome stands high in the list. It is a rare skeletal disorder primarily characterized by short neck with decreased movements and low posterior hairline. It is believed to be caused by faulty segmentation of mesodermal somites. It is associated with other anomalies like cardiac and renal anomalies, deafness, scoliosis etc which make the anaesthetic management difficult.The technique of anaesthesia decides the outcome of patient. Here we present two cases of Klipple Feil Syndrome with skeletal and  renal anomalies posted for laparotomy for malignant ovarian mass done successfully under regional anaesthesia and emergency LSCS done under general anaesthesia.

In trauma cases, blunt trauma abdomen  may be associated with head injury. Patient may die due to intra- bdominal bleeding. There may be minute diaphragmatic tear that may be undetected in USG. In absence of pneumo-thorax patient may develop life threatening pleural effusion (non- pathological) due to pressure gradient between intra - abdominal cavity & pleural cavity. The lung collapse may develop due to pleural effusion.During conservative management of cases of blunt trauma abdomen, patient may succumb due to such type of complication. Timely inter-vention either by inter-costal drainage & under water seal technique or surgical exploration of abdomen & repair of diaphragmatic tear is important to save life of patient. In the present case, patient was survived by timely inter costal drainage tubing with under water seal.   

 Keywords: Brain Dead Donor; Organ Retrieval; Directed Tissue Donation. 

 Takotsubo cardiomyopathy (TTC), also transient apical ballooning if the left ventricle is a recently described and often underdiagnosed entity. The syndrome observed pre-dominantly in the postmenopausal women with signs very mimicking acute myocardial infarction. In most of the case reports emotional or physical stress factors has been identified as a trigger and perioperative stress has been suggested as the trigger in some cases. Outcome is favourable with the right treatment, though recurrences are possible. Here in this review the etiopathogenesis, diagnosis, prevention and management of this syndrome is elaborately described in terms of literature evidence.

Keywords: ILMA; Tracheal; Intubation; Cervical; Spine 

Background: One of the most commonly used anaesthetic procedure in paediatric surgeries is the caudal epidural block. The aim of present study was to compare the effectiveness, duration of analgesia and motor block after a single dose caudal epidural block with either ropivacaine or bupivacaine in children undergoing infra-umbilical surgery. Methods: In a prospective, randomized, double blind study, sixty children, American Society Association Grade I-II, aged between 1 yr and 6 yr of both sex undergoing infraumbilical surgeries were randomly allocated into two equal groups of 30 children each to receive a caudal block with either 1 ml/kg, 0.2% ropivacaine (Group R) or 1 ml/kg, 0.25% bupivacaine (Group B). Standard anaesthesia induction was conducted in all children. After induction, caudal epidural block was performed in lateral position. By the end of surgery, reversal of muscle relaxation was done and children were extubated. Perioperative haemodynamic parameters were noted. Postoperatively, pain score, duration of analgesia, requirement of rescue analgesia and degree of motor blockade were recorded. Results: No significant differences in demographic data as well as duration of surgery were recorded. Haemodynamics were not different in two groups. Postoperative pain score, duration of analgesia and requirement for rescue analgesic were comparable in two groups. However, degree of motor block was significantly less in ropivacaine group. Conclusion: Caudal ropivacaine provides effective analgesia comparable to bupivacaine and as ropivacaine possessing less motor blockade makes it a suitable agent for caudal epidural block in children.

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