| 1. Anaesthetic Management of A Patient with Triple Vessel Disease. Poor left Ventricular Function, Diabetes
Mellitus, and Morbid Obesity for Biventricular Pacing with ICD Placement
Gauri Sankhe, Pradnya Kulkarni, DK Baheti
We report this case to highlight the
difficulties encountered in conducting anaesthesia for a high risk
patient in cardiac catheterization laboratory. Opioid induction is
commonly used technique in patients with poor left ventricular
function. Opioid induction has demonstrated smooth induction,
maintenance. A 46 yr old male with BMI as a V posted for biventricular
pacing with ICD. Patient was a case of hypertension, diabetes mellitus.
Patient had past history of brainstem stroke in 1998. He was treated
for the same and completely recovered. Patient was on
antihypertensives, insulin, antiarrhythmics and hypolipidaemic drugs.
Patient was refractory to antiarrhythmics and diagnosed to have
repeated episodes of ill sustained ventricular tachycardia. He had
repeated episodes of pulmonary oedema which needed hospitalization.
After preanaesthetic evaluation the patient was taken on table.
Angiography was done under local anaesthesia. Immediately patient
developed pulmonary oedema. General anaesthesia with controlled
ventilation was administered in view of treatment of pulmonary oedema
and completion of procedure. Induction was done with opioid and low
dosage hypnotic. Maintenance was on TIVA. Ventricular tachycardia and
ventricular fibrillations were induced to test ICD. Intra and
postoperative period was uneventful. Patient was electively ventilated
in the postoperative period for 12 hours. Patient was discharged from
ICU after 72 hours and one month follow up showed improved left
ventricular function.
2. Pilonidal sinus excision and primary closure
MM Begani, Naresh Row
To show the possibility of local block for pilonidal sinus excision and closure.
With proper cases selection and practice, field block anaesthesia can be used for excision and primary closure
of pilonidal sinus. 150 cases of primary and recurrent pilonidal sinus cases operated over a period of 6 years. Use of
field block with a combination of 2% lignocaine HCl and 0.5% bupinavacain with IV sedation was done in all cases.
Dye sonogram was performed on table with complete excision of all the tracts, followed by primary closure done in
two layers.
2 patients had recurrence, where dehiscence of wound and non-healing required repeat surgery. The rest of the
patient did not have any untoward complication and retured to normal activity within 48 hours. Excision and primary closure
of pilonidal sinus can be safely performed under local field block in trained hands.
3. Congenital Muscular Torticollis - Endoscopic Surgical Correction by Trans-axillary Approach
D Vartak, SR Tambwekar, K Khadalia, VS Tambwekar, R Ginwalla
Congenital muscular torticollis (CMT) results
from fibrosis and subsequent shortening of one sternocleidomastoid
(SCM) muscle. The exact pathology leading to the contracture is not
known. However it may be secondary to trauma or ischaemia which may
result in pseudo tumour colli (in the junction of the middle and distal
third of the muscle). The primary insult could be birth trauma or an
abnormal in-utero head-position or the cause may even be myodysplasia
of genetic origin.
Muscular torticollis can cause severe limitations of neck position and, over time, may result in significant
craniofacial deformation.
Surgical intervention is done to release, lengthen or excising a segment of the sternocleidomastoid muscle
leaving visible scars in the neck which draw attention to the otherwise not-so-significant SCM asymmetry. Two cases have
been done by this method.
4. Median Sternotomy Dehiscence : A Multi-Faceted Approach to a Complex Problem
RF Ginwalla, SR Tambwekar, K Khadalia, VS Tambwekar, DN Vartak
The standard approach used to expose the heart, great vessels and mediastinum is via the median sternotomy.
With the advances in cardiothoracic surgery in recent years, this incision has become commonplace, as have its
concomitant complications, such as wound dehiscence.
All patients who were referred to us had gaping chest wounds with chronic sinuses. Almost all the patients
were diabetic, and presented form 1-8 months post-CABG. All diabetics were put on Insulin.
Multiple therapeutic modalities were initiated to help clean up the heavily infected granulation tissue...
We have found that Median Sternotomy Dehiscence is an extremely morbid complication for the patient, who
is usually depressed, and physically and financially depleted. A multi-disciplinary step-by-step approach is required,
and the patient frequently needs counseling regularly, as a patient, slow-and-steady pre-and-post operative management
is what works best. 5. A large lipoma of the thigh operated under LA : Case Report
Niranjan Agarwal, MM Begani
To report a case of large lipoma of the thigh operated under local anaesthesia in a case considered unfit for any
other form of anaesthesia. 70 years old male patient presented with a large swelling in the back of his left thigh. Extending
from the gluteal fold up to the popliteal fossa. Half encircling the thigh, about 19 x 17 cm since 2 years causing difficulty
in walking and sitting. Patient was a known hypertensive with poor cardiac function, fitness for surgery was given only
for local anaesthesia. Careful and selective utilization of local anaesthesia can be safely used for cases where general
or regional anaesthesia is contraindicated.
6. General surgeries under local anaesthesia
MM Begani, Niranjan Agarwal, Naresh Row
To present retrospective analysis of the increasing spectrum of general surgical cases which can be performed
under local anaesthesia. The advent of better anaesthetic agents, it has been possible to perform a large number of cases
under local/regional anaesthesia. Many minor and major cases can be easily performed, thus reducing the side effects and
risks involved with other types of anaesthesia. Especially if the patient is not fit for any other type of anaesthesia,
this method of administering block is very helpful. Over the past 20 years, we have performed more than 15,000 cases.
We have evaluated statistics of the past 3 years, which we will be presenting to you. With proper training and experience,
a surgeon can perform a large number of cases under local blocks.
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