Introduction: Uterine rupture is a rare but potentially fatal complication of pregnancy. The incidence of uterine rupture is estimated to be between 0.3 and 11 per 10,000. Additionally, uterine sacculation is a sac or outpouching of the uterus that can lead to uterine rupture in pregnancy. Here we describe a case of a patient who was found to have a uterine sacculation on point-of-care ultrasound in the emergency department (ED) that was complicated by uterine rupture. Case Report: A 32-year-old female at approximately 18 weeks gestation presented to the ED with three days of abdominal discomfort. The patient’s medical history was significant for prior uterine fibroids requiring recent myomectomy. On arrival the patient was tachycardic, and her abdominal exam revealed distention with mild tenderness to palpation in all quadrants. A point-of-care transabdominal obstetric ultrasound was performed to evaluate the fetal heart rate, which was 157 beats per minute; it also revealed a defect in the uterine wall compatible with a uterine sacculation. The patient underwent magnetic resonance imaging, which revealed a sac-like structure in the fundal portion of the uterus containing a portion of gestational sac and pregnancy contents. Subsequently, she became hypotensive and tachycardic and was taken emergently to the operating room for concern for uterine rupture. Intraoperatively, uterine rupture was confirmed. The patient underwent surgical repair with evacuation of fetal tissue and recovered in the surgical intensive care unit. Conclusion: Point-of-care ultrasound is a useful and readily available procedure to identify uterine sacculation. Early identification can help escalate the urgency of the patient complaint and may lead to a need for further maternal-fetal evaluation. Emergency physicians should keep a high index of suspicion when evaluating the pregnant patient with a history of uterine surgery.

Background and Aim: The purpose of this study was to compare the efficiency of nasotracheal intubation (NTI) using a Macintosh laryngoscope with bougie to a Macintosh laryngoscope without bougie on-time of intubation, the incidence of postintubation bleeding, hemodynamic stress response, and postoperative complications. Materials and Methods: The present randomized blind research was carried out on 120 patients undergoing elective surgeries under general anesthesia. The study population was separated into two groups, each with 60 patients. NTI was performed with bougie using a Macintosh laryngoscope in Group 1 (n = 60) and without the use of a bougie in Group 2 (n = 60) using a Macintosh laryngoscope. Results: In Group 1, 47 (78.33%) patients were successfully intubated in the first attempt, and 13 (21.67%) patients were successfully intubated in the second attempt, whereas in Group 2, 38 (63.33%) patients were intubated in the first attempt and 22 (36.67%) patients required second attempt, with a statistically significant difference. In Group 1, the mean time required for intubation was 31.10 ± 2.36 s, and in Group 2, it took 43.08 ± 2.17 s, P value was statistically significant. In Group 1, the number of patients with a sore throat was 5 (8.33%), with dental injury was 4 (6.67%), and with nasal mucosa laceration was 3 (5%). In Group 2, the number of patients with sore throat was 6 (10%), with dental injury was 6 (10%), and with nasal mucosa, laceration were 5 (8.33%). The difference was not significant in both the groups. Hemodynamic variables were comparable among the groups. Conclusion: Bougie-guided NTI resulted in more successful intubation in terms of less number of attempts, less time taken for intubation, and less postintubation bleeding as compared to NTI without bougie.

We report the case of a 60-year-old male posted for surgery on the left inner thigh mass with extensive neurofibromas covering the whole body. The patient was administered a subarachnoid block at L3-L4 level for excision of the mass on the left inner thigh. There were no postoperative anesthetic complications. This case report aims to highlight the importance of regional anesthesia in patients with neurofibromatosis and its anesthetic implications.

Introduction: Peripheral neural blockade is now a well-accepted component of comprehensive anesthetic care. Many adjuvants such as dexmedetomidine, clonidine, opioids, ketamine, and midazolam and corticosteroids have been used; however, still the search for ideal adjuvant is in process. The purpose of this study was to investigate whether addition of 8 mg dexamethasone to local anesthetic solution for brachial plexus block would prolong the period of postoperative analgesia. Materials and Methods: This was a prospective double-blind randomized controlled trial. Forty patients between the age of 20 and 65 years, of either sex of the American Society of Anesthesiologists Grade I-III, who were undergoing upper limb surgery, were selected to study the quality of brachial plexus block and duration of postoperative analgesia produced by addition of dexamethasone to local anesthetic solution versus plain local anesthetic solution in the infraclavicular brachial plexus block. Results: Demographic parameters such as age, weight, height, and body mass index were comparable between two groups with P > 0.05. We also observed that onset of sensory and motor block was earlier in Group I, and duration of motor and sensory block was more in Group I. There was a less requirement of postoperative analgesics. Furthermore, the incidence of postoperative complications was less in Group I compared to Group II. Conclusion: We conclude that addition of dexamethasone to local anesthetic solution for brachial plexus block sets the sensory block early, increases the duration of sensory block without any side effect, provides improved patient comfort, effective pain relief, and decreases the requirement of postoperative supplementary analgesic.