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Author Topic: How to Use This Section  (Read 3682 times)

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gasman

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How to Use This Section
« on: December 09, 2004, 06:56:35 PM »
The "Ask an Expert" board is for problem solving. If you have a difficult clinical case coming up that you want some expert opinion with, post the scenario on this board.

If you consider yourself an expert or at least very experienced in the area covered by the topics, feel free to offer advice as to management.

Please read our Disclaimer in the News Section - bottom line is that you use the advice provided here at your own risk, and the advice posted here is in no way a substitute for a thourough reading of the relevent literature.

Please also read our Privacy Issues post - keep all patient details confidential.

Even so, this board should help us in those "unique" and sticky situations that the literature may not cover.

cheers
Rob Lang
« Last Edit: December 13, 2004, 09:19:14 PM by Robert Lang »
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sanjay

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Re: How to Use This Section
« Reply #1 on: September 09, 2006, 10:15:31 PM »
The "Ask an Expert" board is for problem solving. If you have a difficult clinical case coming up that you want some expert opinion with, post the scenario on this board.

If you consider yourself an expert or at least very experienced in the area covered by the topics, feel free to offer advice as to management.

Please read our Disclaimer in the News Section - bottom line is that you use the advice provided here at your own risk, and the advice posted here is in no way a substitute for a thourough reading of the relevent literature.

Please also read our Privacy Issues post - keep all patient details confidential.

Even so, this board should help us in those "unique" and sticky situations that the literature may not cover.

cheers
Rob Lang

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sanjay

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Re: How to Use This Section
« Reply #2 on: September 09, 2006, 10:51:02 PM »
sir
I have a case report on which i require the expert opinion as to the cause of the particular intraoperative event.
A 55 years male was posted for sublabial trans-sphenoidal pituitary tumor excision.Pre op. investigation were within normal limit.ECG was normal,CXR showed increased bronchopulmonary markings.He was a non smoker.Induction of anaesthesia was done with inj.midazolam(0.03mg/kg),sufentenil(0.5 mcg/kg0,thiopentone 4mg/kg.Intubation was done after giving vecuronium0.15mg/kg ,with no.8.5 cuffed ETT.Maintainence of anaesthesia was done with N2O,O2(66:33),isoflurane,and incremental dose of vecuronium and sufentenil.15 minutes after intubation patient started desaturating,SRO2 decreased to 92-93%.Air entry was checked and found to be equal,airway pressure was also normal.100% oxygen was given which improved saturation to100%.ABG done showed(FIO2=.33)pH7.3,pCO2  47.8,pO2  83.6,HCO3  23.1,BE -3.5.SaO292.8
Ventilation was continued with 100%O2.Repeat ABG (FIO2=1)showed pH7.4,pCO2  36.3,pO2  135.6,HCO3  24.2.1,SaO2  99.Surgery was continued .In the first half of surgery whenever N2O  was switched SPO2 decreased,however in the latter half 50% N2O could be used without fall in SPO2.Neuromuscular effect was reversed with neostigmine+glyco. Patient was awake, following commands,SPO2100%,shifted to recovery with O2 by ventimask@FIO20.5,nursed in propped up position.
Postoperative course was uneventfuland patient discharged home 3 days after surgery.

    I will be oblidged if anyone can answer our Query as to the cause of this particular event where switching on N20 decreased SPO2 but patient maintaining saturation with 100% o2



Thanking You
Sanjay Agrawal
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HARIH77V

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Re: How to Use This Section
« Reply #3 on: January 04, 2007, 03:34:31 AM »

Was it isolated masseter spasm

Young patient aged 25 yrs. posted for post partum sterilisation - investigations within normal limits,no positive history,general physical examination within normal limits.Premedicated with Inj.ondensatron 4mg iv,inj.pyrolate 0.2mg iv - pre oxygenated induced with inj.propofol 100mg + inj.succinylcholine 80mg.iv - maintained with  4L. N2O +2L.O2 - IPPV with 3 no. mask - Bain circuit.After 5 minutes patient became very rigid specially her masseter muscle went or spasm - tried endotracheal intubation - failed - tried blind nasal - failed- somehow maintained with bag and mask ventilation.There was no rise of temperature.Circuit was changed,N2O was stopped.There was severe desaturation.Somehow patient recovered completely.What was the cause of these events?Should the patient be told to be cautious if she goes for further surgeries?
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