Indian Journal of Anesthesia and Analgesia

Ankylosing spondylitisis a chronic, progressive autoimmune inflammatory disorderaffecting the musculoskeletal system, can have large spectrum of underlying comorbidities. The multisystem involvement with Ankylosing spondylitis and Parkinson’s disease has its own characteristic involvement of organs. Here is a case report of association of Ankylosing Spondylitis and Parkinson’sdisease with multiple comorbidities involving various other systems and anesthetic management of the same when he was scheduled for thoracic spine surgery for D9-D10 fracture under neuro-navigation in a prone position.

Ankylosing Spondylitis is an autoimmune seronegative spondyloarthropathy which manifests as a relapsing remitting disease. Since the disease involves the spine, it becomes significant for anesthesiologists as ensuring airway control in general anesthesia, and regional neuraxial blockade becomes difficult. Hence the anesthesiologist should be prepared beforehand with the anesthesia plan and the backup plan if the primary plan fails. In this report, we highlight the anesthetic management of a 66 year-old male who was a known case of ankylosing spondylitis and was planned for a total hip replacement.

In elderly hip fractures are common presentations which require surgical intervention. These patients have increased morbidity and mortality due to associated comorbidities like renal, cardiac, respiratory, endocrine or neural diseases. Chronic kidney disease is one of the common complications of long standing uncontrolled hypertension and diabetes mellitus. Patients with CKD are exposed to an increased risk for adverse outcomes and further perioperative injuries resulting from hemodynamic instability, hypovolemia, or drug toxicity, each of which has the potential to aggravate renal dysfunction, ultimately leading to end stage renal disease, and reduced long-term survival. It is estimated that there are approximately 7.85 million chronic renal failure patients in India.1 Diabetes mellitus and hypertension reaching epidemic proportion in urban population and chronic kidney disease being inevitable in long standing untreated cases, providing anesthesia to patients with chronic kidney disease poses a challenge.

Case Report: A 48yr old male presented with bilateral neck of femur fracture following fall from height and was planned for bilateral hip arthroplasty. Patient is a known case of CKD on maintenance haemodialysis. He is also a known hypertensive, diabetic and seizure disorder on treatment. Patient has underwent epidural anesthesia.

Conclusion: We present a successful anesthetic management of a dwarf patient with bronchial asthma and hypothyroidism who underwent hysterectomy. We emphasize the risk of neurological injury while extending the neck during laryngoscopy for tracheal intubation due to anatomical abnormalities in these patients. A detailed pre anesthetic evaluation evaluation and planning is utmost important and the anesthetic technique has to be individualized based on the patients anatomical characterstics and associated co-morbidities.

Background: Ropivacaine, the pure S enantiomer of propivacaine, due to its less lipophilicity than bupivacaine does not produce cardiotoxicity or neurotoxicity and causes less motor blockade. Dexmedetomidine the newer selective alpha 2 adrenergic agonist has several advantages when given through epidural route as a neuraxial adjuvant.

Aim: To compare 0.75% Inj. Ropivacaine with Inj. Fentanyl and 0.75% Inj. Ropivacaine with Inj. Dexmedetomidine epidurally for the duration of analgesia, hemodynamic changes, degree of motor blockade and occurrence of side effects.

Materials and Methods: 60 patients undergoing lower limb, lower abdomen surgeries were randomized to two groups. Group RF (n=30) received 0.75% Inj. Ropivacaine 15 ml with Inj. Fentanyl 1 mcg/kg in 2 ml preparation. whereas Group RD (n=30) received 0.75% Inj. Ropivacaine 15 ml with Inj. Dexmedetomidine 1 mcg /kg in 2ml preparation. Quality of sensory block, motor block, pulse rate, blood pressure, pain assessment and any adverse outcome were noted.

Results: Dexmedetomidine fastens the onset of analgesia, prolongs the duration of analgesia thereby reducing the doses of rescue analgesics post operatively, improves the quality of motor blockade without aggravating changes in haemodynamic parameters and has less adverse effects.

Conclusion: We conclude that dexmedetomidine serves as a good neuraxial adjuvant when added to 0.75% ropivacaine in epidural anesthesia given for lower limb, lower abdomen surgery.

Background and Objectives: Induction of anesthesia is a critical part of anesthesia practice. Sudden hypotension, arrhythmias, and cardiovascular collapse are threatening complications following injection of induction agent in hemodynamically unstable patients. Present prospective randomized study is designed to compare propofol and etomidate for their effect on hemodynamics in patients undergoing general anesthesia.

Methods: Hundred ASA I and II patients of age group 18-60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into two groups of 50 each receiving propofol (2 mg/kg) and etomidate (0.3 mg/kg) as an induction agent. Vital parameters at induction, laryngoscopy and thereafter recorded for comparison.

Results: Demographic variables were comparable in both the groups. Patients in etomidate group showed little change in mean arterial pressure (MAP) and heart rate (HR) compared to propofol (p > 0.05) from baseline value.

Conclusions: This study concludes that etomidate is a better agent for induction than propofol in view of hemodynamic stability.

Context: Aims: To compare two supra glottic airway devices, Ambu auragain & proseal LMA in terms of their working performance & insertion characteristics during general anesthesia in patient undergoing elective laparoscopic surgery.

Settings and Design: After written informed consent, 60 patients of ASA I & II, aged 18 to 60 years, of either gender posted for laparoscopic surgery under general anesthesia were included in the study. Patients were divided into two groups of 30 patients each.

Methods and Material: In group A: airway was secured with Ambu Auragain & in group P: with Proseal LMA for general anesthesia. Working performance (in terms of oropharyngeal leak pressure) and insertion characteristics (insertion time, manipulations of device, number of attempts) were recorded at the time of induction. Haemodymanics (Heart rate, mean arterial blood pressure, SpO2) & complications (if any) were recorded perioperatively.

Statistical Analysis used: Student t test for quantitative data & Chi square test for qualitative data.

Results: Oropharyngeal leak pressure was significantly higher & insertion time was significantly less in group A compared to group P (P<0.0001). There was no statistically significant difference in insertion characteristics, demographic data, haemodynamics, ease of orogastric tube & post operative complications in both the groups. Conclusions: AmbuAuragain provides higher oropharyngeal leak pressure with lesser insertion time compared to ProSeal LMA.>>0.0001). There was no statistically significant difference in insertion characteristics, demographic data, haemodynamics, ease of orogastric tube & post operative complications in both the groups.

Conclusions: AmbuAuragain provides higher oropharyngeal leak pressure with lesser insertion time compared to ProSeal LMA.