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   2016| January-June  | Volume 17 | Issue 1  
    Online since June 17, 2016

 
 
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LETTER TO EDITOR
“Zero” diastolic blood pressure
Deepak Choudhary, Om Prakash Suthar, Pradeep Kumar Bhatia, Ghansham Biyani
January-June 2016, 17(1):32-33
DOI:10.4103/0973-0311.183572  
  29,003 634 1
CASE REPORTS
Anesthetic management of a child with autistic spectrum disorder and homocysteinemia
Deepak Choudhary, Ghansham Biyani, Pradeep Kumar Bhatia, Nikhil Kothari
January-June 2016, 17(1):29-31
DOI:10.4103/0973-0311.183573  
Autistic spectrum disorder (ASD) is a developmental disability of the central nervous system with rapid worsening. A subset of patients also has mitochondrial dysfunction leading to increased sensitivity to various anesthetic agents. Rarely, gene mutation in these patients results in homocysteinemia which causes higher incidences of thromboembolism, hypoglycemia, and seizures. Anesthetic management of ASD with homocysteinemia and refractory seizures has not been previously reported.
  6,319 470 -
GUEST EDITORIAL
On starting a new medical journal: Problems, challenges, and remedies
Anjan Trikha
January-June 2016, 17(1):3-5
DOI:10.4103/0973-0311.183576  
  6,106 648 2
CASE REPORTS
Anesthetic management of lower segment cesarean section with postpartum hemorrhage in two patients with tetralogy of Fallot
Jayashree Patki, Nareshkumar Reddy
January-June 2016, 17(1):10-13
DOI:10.4103/0973-0311.183577  
Pregnant patient with heart disease is a unique challenge to the obstetrician and anesthesiologist, and requires a thorough understanding of the impact of pregnancy on the haemodynamic response in view of existing cardiac lesion. Among the congenital heart diseases causing right to left shunt, Tetralogy of Fallot (TOF) is commonest congenital heart disease. Symptoms of TOF may get worsened during pregnancy and if neglected, it causes significant morbidity and mortality to the patient as well as to fetus. Uncorrecrected TOF parturient posted for LSCS poses an unique challenge to the anesthesiologist. We present 2 case reports of patients of TOF with BT shunt who underwent caesarean section under general anaesthesia. Both the patients had post partum hemorrhage (PPH) which was treated successfully without further complications
  5,794 600 -
Combined spinal–epidural anesthesia for an elderly patient with proportionate dwarfism for laparotomy
Teena Bansal, Rajmala Jaiswal, Arnab Banerjee
January-June 2016, 17(1):14-16
DOI:10.4103/0973-0311.183578  
Anesthesia in a dwarf patient may be challenging as various anatomical anomalies make both general and regional anesthesia difficult. These patients may have atlantoaxial instability, potential for airway obstruction, and associated respiratory problems that may pose problems for general anesthesia. Spinal stenosis, osteophytes, short pedicles, or a small epidural space could complicate regional anesthesia in dwarfs which could lead to difficulties in locating the epidural space and increase the risk of dural puncture. Spinal stenosis may impair cerebrospinal fluid flow such that identification of dural puncture is difficult. This elderly dwarf patient had history of bronchial asthma with restriction of neck extension, managed successfully using combined spinal–epidural anesthesia.
  4,907 658 -
Posterior reversible encephalopathy syndrome: An atypical postpartum complication
Debashish Paul, Sachin Narayan Kulkarni, Mili Das Choudhury, GD Maity
January-June 2016, 17(1):17-20
DOI:10.4103/0973-0311.183579  
Posterior reversible encephalopathy syndrome (PRES) is presented by headache, altered mental status, blurring of vision, vomiting and seizure in conjunction with radiological finding of posterior cerebral white matter edema. Data suggest that most cases occur in young middle-aged with marked female preponderance, hypertension being the most common cause. In this case, it was diagnosed in a normotensive patient in the postnatal period that underwent cesarean section. The initial symptoms had misled toward a diagnosis of postdural puncture headache. Symptomatic treatment was started immediately in the ICU. This is an interesting case as the patient was a normotensive one without any other contributory factors and there was unanticipated delay in diagnosing the case until the time we could get a magnetic resonance imaging report.
  4,997 538 -
Severe intraoperative hypercarbia undetected by continuous end-tidal CO2 monitoring in a chronic smoker undergoing one-lung ventilation
Shagun Bhatia Shah, Binod Kumar Naithani, Vani Bhageria, Ajay Kumar Bhargava
January-June 2016, 17(1):21-24
DOI:10.4103/0973-0311.183580  
One-lung ventilation is known to alter the physiology and result in a discrepancy between end-tidal CO2 (ETCO2) and arterial blood CO2partial pressure despite protective mechanisms like hypoxic pulmonary vasoconstriction. Shunts in an emphysematous patient, lateral positioning and capnothorax may aggravate the discrepancy. We present here an incredible discrepancy of 40 mmHg which led us to question the very utility of ETCO2monitoring in this subset of patients and consider alternative techniques.
  4,690 524 -
Clinical pearls of anesthesia for radio-guided, robot-assisted retroauricular parathyroidectomy
Soumi Pathak, Itee Chowdhury, Nitesh Goel, Col A. K. Bhargava
January-June 2016, 17(1):6-9
DOI:10.4103/0973-0311.183575  
Robot assisted transaxillary and retroauricular parathyroidectomy provides a safe, precise, 3-dimensional (3D) magnified dissection for parathyroid surgery without the need for CO2insufflation, and with a better cosmetic outcome due to an invisible scar in the axillary or retroauricular region. Robotic surgery requires innovations with regard to patient positioning and the overall arrangement of operative equipment and personnel. Anaesthesiologists should become familiar with these changes by learning the basic features of robotic surgical systems to provide good anaesthetic care.
  4,527 587 -
Anesthetic concern during cesarean delivery in patient with ruptured cerebral arteriovenous malformation
Rakesh Karnawat, Sadik Mohammed, Snehil Gupta, Naveen Paliwal, Meenal Agarwal
January-June 2016, 17(1):25-28
DOI:10.4103/0973-0311.183571  
Vascular malformations of the brain are a rare cause of intracranial hemorrhage during pregnancy. The presentation of arteriovenous malformations during pregnancy is usually a result of hemorrhage following rupture. Once hemorrhage occurs, it accounts for 5–12% of all the maternal deaths and remains the third most common nonobstetric cause of maternal morbidity. Successful anesthetic management during cesarean delivery requires close monitoring to address both the varying maternal and fetal needs. The fundamental aims are to maintain oxygenation and stable systemic, cerebral, and placental hemodynamics and to avoid increase in intracranial pressure.
  4,500 508 -
EDITORIAL
The journal in a new avatar
Pradeep Kumar Bhatia
January-June 2016, 17(1):1-2
DOI:10.4103/0973-0311.183574  
  4,317 582 -