Journal of Clinical Anesthesiology: Open Access

Introduction: Stroke is an ischemic/embolic or hemorrhagic cerebrovascular event that can occur at any time. Meanwhile, intravenous or endovascular intra-arterial thrombolysis is the current standard therapy for intracranial intravascular clots, embolic occlusion of a major intracranial vessel occasionally requires microsurgical embolectomy. In particular, when the embolus is a large atherosclerotic plaque or foreign body (such as a balloon or microcoil from endovascular treatment), surgery may be the treatment of choice.

Case history: This is a 70 years old female patient who came with a chief complaint of ‘failure to communicate of 12 hrs duration’ and diagnosed to be recurrent 2˚stroke+old Rt side stroke+type II DM+HTN.

Discussion: Several studies have demonstrated that patients who received general anesthesia for treatment are less likely to have a good outcome than those managed with local anesthesia. This may be due to preintervention risk not included in the stroke severity measures.

Summary: Neuroanaesthesia is a dynamic and rapidly advancing sub-specialty where anesthetic technique can have a real impact on both operative conditions and patient outcomes. Advanced airway skills, multimodal monitoring, and the management of challenging and complex cases are required on a regular basis.

Conclusion: Preintervention risk should always be minimized and blunted to avoid stroke severity and also to avoid irreversible ischemic damages. Additionally, preoperative routine medication with statins and b-blockers should be continued during the perioperative period and also propanol infusion should be considered to replace N2O, Mannitol 0.5 g/kg-1 g/kg, Furosemide 0.3 mg/kg for better lumbar CSF drainage and brain relaxation.

Control of blood pressure is critical for this patient to have successful outcomes and progress and also to avoid the risk of postop hemorrhage. This is mainly because an acute ↑↑ BP →↑↑ transmural pressure across the aneurysmal wall → ruptures of the aneurysm and course body temperature should be maintained normothermic to have good recovery and progress.

Background and Objectives: Clonidine is a partially selective alpha-2 adrenergic agonist and has extensively been studied intrathecally in regional anaesthesia. With this background, the present study was conducted to compare the clinical efficacy of two different doses of intrathecal clonidine in hyperbaric bupivacaine with hyperbaric bupivacaine alone in terms of duration of post-operative analgesia, quality of surgical anaesthesia, incidence of hypotension and bradycardia in lower limb orthopedics surgeries.

Methods: Total of 150 patients was randomly allocated to 3 groups of 50 patients each. Group I received 2.5 ml of 0.5% hyperbaric bupivacaine+1 ml NS (Normal Saline); Group II received 2.5 ml of 0.5% hyperbaric bupivacaine+0.5 ml clonidine (75 mcg)+0.5 ml NS; group III received 2.5 ml of 0.5% hyperbaric bupivacaine+1 ml clonidine (150 mcg). Intraoperatively, onset of sensory and motor block, highest sensory level achieved, time to reach it, haemodynamic parameters and sedation scoring were noted. Postoperatively haemodynamics, duration of sensory/motor block, sedation and duration of effective analgesia were noted.

Results: Group II patients had effective postoperative analgesia with excellent quality of surgical anaesthesia, effective sedation score and showed significant hypotension. Group III patients had highest incidence of bradycardia.

Conclusion: This study concluded that 75 mcg clonidine is an effective adjuvant to 0.5% hyperbaric bupivacaine when used intrathecally in lower limb orthopaedic surgeries. Incidence of hypotension and bradycardia is lesser in 75 mcg than 150 mcg clonidine.

Temperature monitoring is an important modality of monitoring and is included in minimum monitoring standards. LMA Gastro Airway has wide diameter gastric channel that allows entrance of endoscope during endoscopy. We have added an innovative thought to the functioning of this airway where gastric tube and temperature probe are passed through the gastric channel during the surgical procedure. This will provide core body temperature throughout the duration of surgery in operation theatre and during endoscopic procedure under general anaesthesia. When smaller diameter endoscope is entered through gastric channel, temperature probe can also be introduced in that tube to measure temperature continuously.

Perineural dexamethasone appears to prolong the duration of analgesia after brachial plexus block when combined with local anaesthetics. Several studies have compared intravenous with perineural dexamethasone in upper extremity surgeries, however there is concern regarding potential neural toxicity of perineural dexamethasone; Therefore we  aimed to find out whether intravenous dexamethasone compared to perineural dexamethasone had similar or superior effects in prolonging the duration of nerve block, as adjuvant to local anaesthetic  brachial plexus block.

This randomized, prospective observational study was conducted on 222 patients,in govt.medical college hospital, thiruvananthapuram, posted for upperlimb forearm surgeries under supraclavicular brachial plexus block with duration of analgesia as the primary outcome. The Study period was from December 2016 to June 2018 (1.5 years)  after getting clearance from Institutional Ethics Committee and study duration was 1 ½ years. Analysis was  done using Excel 2007 worksheet and SPSS 16 statistical software Qualitative data were expressed in proportion and percentage. Quantitative data expressed as mean and SD. Bivariable analysis was done using students t-test and chi-square test. The supraclavicular block lasted significantly longer in patients who received intravenous dexamethasone compared with perineural dexamethasone (p=0.001).With respect to secondary outcomes, there was a reduction in total post operative morphine equivalent administration in perineural dexamethasone compared with intravenous dexamethasone  (p = 0.002).We have concluded that 8 mg of intravenous dexamethasone  extended the duration of analgesia and reduced pain scores. We suggest that intravenous dexamethasone be preferred, as its use is licensed and the possibility of neurotoxicty is avoided.

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