Huge goiters can lead to tracheal compression and, hence, difficulty in endotracheal intubation. This along with retro-sternal extension makes it an anticipated difficult airway scenario. In this report, we present a case of huge goiter (papillary carcinoma) compromising the airway, which presented with difficult airway for total thyroidectomy. CT scan of neck revealed retro-sternal extension with the pretracheal plane fixed to the trachea. Trachea was completely pushed to the right. We successfully performed an awake direct laryngoscopy and successful intubation by locally anesthetizing the airway. Plan B was ready with fiberoptic bronchoscopy and rigid bronchoscopy. Patient was successfully extubated in the intensive care unit (ICU).

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Hyperreactive airway disease occurs due to acute viral or bacterial infections in children, and due to chronic bronchitis, Asthma or Emphysema in adults. Smoking and exposure to allergens may worsen the disease. Anaesthesia in these patients is associated with higher incidence of perioperative bronchospasm, postoperative laryngospam, breath holding, and hypoxia due to maldistribution of Ventilation and Perfusion. Smoking and exposure to allergens may worsen the outcome. Severe bronchospasm is a life threatening emergency. Selective β2 agonists form the main drug of choice for bronchospasm. Corticosteroids should be given early to reduce inflammation and mucosal oedema. For anaesthesia, Propofol, Vecuronium or Rocuronium, Halothane or Sevoflurane and Fentanyl are drugs of choice. Histamine releasing drugs like morphine and atracurium should be avoided. If ventilator support is required, Non invasive Pressure Support ventilation should be used first. However, Intubation and mechanical ventilation may become necessary, which however, may be associated with difficult weaning.

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Pethidine is used by anesthesiologists to provide pain relief during the perioperative period, labor, and trauma, but it is not frequently used nowadays because of the availability of more potent shorter-acting opioids. But even today it is commonly used by many to alleviate shivering in surgical patients. Because of these actions on the autonomic nervous system, pethidine may produce changes in the heart rate in combination with other medications or interventions. We encountered ill-sustained complete heart block in a patient who received 25 mg pethidine intravenously to alleviate shivering. No other treatment except 0.2 mg glycopyrrolate was required as the patient had hemodynamic stability.

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Thrombocytopenia is a common manifestation in pregnancy. It is mostly dilutional when no pathological causation is evident. There are no clear-cut guidelines to determine the platelet count at which anesthesiologists can safely administer regional anesthesia in obstetric patients. A safe approach in an asymptomatic mother is outlined here.

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Background: Laryngoscopy and intubation are intensely stimulating procedures and can induce marked sympathetic responses. We hypothesized that by minimizing the oropharyngeal stimulus with Bonfils rigid fiberscope intubation, the hemodynamic responses to endotracheal intubation will be lesser. Therefore, we compared Bonfils intubation with conventional direct laryngoscopic intubation in adult patients with normal airway. Materials and Methods: Sixty adult patients of either sex, belonging to American Society of Anesthesiologists grade 1 or 2, were randomized into Bonfils group and laryngoscopy group, and studied over a 2-year period. Anesthet ic technique was standardized in both the groups. Hemodynamic variables were recorded at pre-induction, induction, post-induction at laryngoscopy and intubation, thereafter for every minute for 10 min, and half hourly till the end of surgery for both the groups. Intubation time, intubation attempts, and postoperative complications like hoarse voice and sore throat were compared between the two groups. Results: There was no statistically significant difference between the two groups with respect to systolic blood pressure, mean blood pressure, and heart rate changes throughout the study period. There was a statistically significant difference in the diastolic blood pressure (DBP) values between the groups (P < 0.05) for the first 10 min following intubation. The time required for intubation was significantly longer in the Bonfils group (36 ± 6 s) compared to the laryngoscopy group (28 ± 6 s) (P = 0.000). The incidence of postoperative sore throat (P = 0.009) and hoarseness of voice (P = 0.045) was significantly lesser in the Bonfils group compared to the laryngoscopy group. Conclusion: There was no clinically significant difference in the hemodynamic changes following intubation using either Bonfils fiberscope or conventional laryngoscope. Bonfils intubation required longer time, but was associated with lesser incidence of sore throat and hoarseness of voice when compared to laryngoscopic intubation.

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Background: In unstable cervical spine, optimal intubation positioning of the patient may be unsafe. Awake intubation is indicated, which is rendered more comfortable by light sedation. Aims and Objectives: This study compared intravenous dexmedetomidine versus propofol-based sedation for awake fiberoptic intubation along with airway blocks. Materials and Methods: 100 ASA I and II patients with cervical PIVD are recruited for this study. Vital parameters such as heart rate, systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and SPO2 were monitored at regular intervals. Patient sedation score, endoscopy score, intubation score, post-intubation conditions, and discomfort score were also recorded. Results: There was no statistically significant difference between the two groups with respect to SBP, DBP, mean blood pressure (MBP), heart rate (HR), and SPO2. Conclusions: Dexmedetomidine appeared to offer better patient tolerance, better preservation of a patent airway, and spontaneous ventilation.

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Today elderly patients with complex health-related issues undergoing successfully a day care ophthalmic procedure are a common scenario. How can these high risk patients safely undergo an eye surgery and be back at home on the same day? This is possible, only when a well-planned, scientifically drawn protocol is in place at an institution. This plan of action takes into consideration every possible detail about the patient and also his or her special requirements if not demands. The anesthesiologist commands these well-set actions and guides the other health care staff to streamline the day care program, thereby sparing the busy ophthalmologist to attend to his clinical and surgical workload.

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