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   Table of Contents - Current issue
Coverpage
October-December 2017
Volume 3 | Issue 4
Page Nos. 69-89

Online since Monday, July 16, 2018

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ORIGINAL ARTICLE  

Comparative study of hemodynamic changes using proseal laryngeal mask airway, intubating laryngeal mask airway or laryngoscopic endotracheal intubation under general anesthesia in patients undergoing coronary artery bypass grafting surgery p. 69
Anjum Saiyed, Abhishek Jain, Indu Verma, Reema Meena
DOI:10.4103/kaj.kaj_16_18  
Introduction: Laryngoscopy and endotracheal intubation alter cardiovascular physiology both via reflex responses and physical presence of an endotracheal tube (ETT). Stress response caused by laryngoscopic endotracheal intubation may be harmful for the coronary or cerebral circulation of high-risk patients. This study aimed to evaluate the hypothesis that placement of Proseal laryngeal mask airway (PLMA) and intubating laryngeal mask airway (ILMA) are associated with less cardiovascular response than the endotracheal intubation via conventional technique. Materials and Methods: In this hospital-based, randomized, interventional study, 105 patients of the American Society of Anesthesiologists Grade II and III undergoing coronary artery bypass grafting surgery under general anesthesia were randomly allocated into three groups, that is, PLMA, ILMA, and ETT. Hemodynamic parameters such as heart rate, blood pressure, cardiac output, cardiac index, systemic vascular resistance (SVR,) and SVR index baseline, during induction and after insertion of device were compared. Results: The study groups were comparable with respect to age, weight, height, gender, and baseline hemodynamic parameters. The heart rate, systolic blood pressure, diastolic blood pressure, and MAP were significantly higher (P < 0.05) in endotracheal group as compared to PLMA and ILMA groups for 15 min following intubation, that is, throughout the study period. However, there was no significant difference between PLMA and ILMA group (P > 0.05). SVR was significantly higher in endotracheal group as compared to PLMA and ILMA group throughout the study (P < 0.05). The cardiac index at all time was not significantly different among the three groups. Conclusion: PLMA and ILMA insertion is accompanied by minimal cardiovascular responses than those associated with direct laryngoscopic endotracheal intubation, so it can be used for patients in whom a marked pressor response would be deleterious.
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CASE REPORTS Top

Flexible intubation videoscope-guided replacement of tracheostomy tube in a carcinoma larynx patient with extensive subglottic involvement p. 76
Deepak Singla, Kasari Masaipeta, T Mageshwaran, Mishu Mangla
DOI:10.4103/kaj.kaj_19_18  
Subglottic narrowing or alteration can cause difficulty in tracheostomy. Although no specific technique has been mentioned in the literature, various procedures have been advocated to increase accuracy and to minimize complications. Here, we describe a case where flexible intubation videoscope was used for successful location of tracheal lumen and insertion of the tracheostomy tube.
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A patient with Cushing's disease for pituitary tumor resection: Anesthetic challenges and management p. 79
Renu Bala, Garima Vashisht, Ishwar Singh, Saquib Siddique
DOI:10.4103/kaj.kaj_6_18  
Adrenocorticotrophic hormone-secreting pituitary adenoma is though quite rare yet carries significant mortality and morbidity due to severe comorbidities associated with them. Transsphenoidal resection of pituitary adenoma is the treatment of choice. While managing these patients, anesthesiologists face hosts of challenges since there are significant alterations in pathophysiology of the body. A thorough understanding of preoperative assessment, intraoperative management, and potential complications is fundamental for successful perioperative outcome. We report a case of Cushing's disease who underwent pituitary tumor resection and discuss the difficulties encountered and their management.
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Anesthetic management of a case of cleidocranial dysplasia p. 82
Arun Sundaram, Shibinath Veluthamanil, Abisha Sahaya Mercyline, Aparna Gilbert, Godwin Jino, Sudha Kumara Dhas
DOI:10.4103/kaj.kaj_10_18  
Hereby, we present the case of an adult with cleidocranial dysplasia who underwent multiple tooth extraction. In this article, characteristics of this genetic disorder and implications for an anesthesiologist are being discussed.
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Anterior mitral leaflet repair in hypertrophic obstructive cardiomyopathy: A tailored approach under transesophageal echocardiographic guidance p. 85
Sucharita Das, S Sridhar, PV Rao
DOI:10.4103/kaj.kaj_7_17  
Hypertrophic obstructive cardiomyopathy (HOCM) is the most common inherited cardiovascular disease, which causes significant involvement of mitral valve in the pathogenesis of left ventricular outflow tract (LVOT) obstruction. A 37-year-old man, a diagnosed case of HOCM, reported to us with complaints of angina and difficulty in breathing. His preoperative echocardiography revealed a predominant LVOT obstruction which caused a resting gradient of 50 mmHg. It was associated with the presence of systolic anterior motion (SAM) and posteriorly directed moderately severe regurgitation jet. Plication of anterior mitral leaflet (AML) was done through transaortic approach while performing septal myectomy. Plicating AML through transaorta was tailored under transesophageal echocardiographic guidance where the height of AML was reduced by 1 cm. As a result, postoperative SAM was significantly reduced. The approach of plicating AML through transaorta became technically simpler with the help of transesophageal echocardiography.
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LETTER TO EDITOR Top

A bizarre scenario during lung isolation due to interchanged double-lumen tube connectors p. 88
Neisevilie Nisa, Ankur Sharma, Bikash Ranjan Rai, Varuna Vyas, Arijit Sardar
DOI:10.4103/kaj.kaj_14_18  
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