No abstract

Clonidine added to a ropivacaine and fentanyl mixture augmented the postoperative epidural analgesia without significant side effects.

A 24-year-old woman with previous undiagnosed congenital methemoglobinemia presented for the emergency cesarean section in view of fetal distress. The patient had a persistent low oxygen saturation on pulse oximetry with normal heart rate and blood pressure. Arterial blood gas values were normal. The patient was asymptomatic and respiratory and cardiovascular system examination was normal. The patient underwent cesarean section under general anesthesia and was shifted to the Intensive Care Unit postoperatively. The oxygen saturation was low throughout the intraoperative and postoperative period. A complete evaluation was done postoperatively. Mass spectrophotometry was done, which confirmed methemoglobinemia in the patient.

Chikungunya viral infection is a mosquito borne illness which is known to have a limited course and complete recovery is seen in most of the patients. However the virus has been reported to have atypical manifestations and lethal complications have been reported in patients suffering from chikungunya infection. In the present outbreak of chikungunya virus in the national capital territory of Delhi we report a case of chikungunya fever in a pregnant female with no significant medical history. The patient developed thrombocytopenia, hepatic injury and disseminated intravascular coagulation and ultimately succumbed to the illness due to cardiovascular collapse.

A 12 year old patient was taken up for adenotonsillectomy. Preoperative and intraoperative course was normal. Reversal of neuromuscular blockade was done with injection Neostigmine and extubation was done after a thorough oropharyngeal examination by the surgeon and anaesthesiologist. Within minutes the patient developed stridor with a fall in oxygen saturation to 77% on room air. Laryngoscopy revealed a gross uvular and posterior pharyngeal wall edema. Patient was immediately intubated and injection Adrenaline, Dexamethasone and Chlorpheniramine maleate were administered. Postoperative serum tryptase and Immunoglobulin E levels were raised. Elective ventilation was done overnight and patient was extubated next day after confirming a reduction in the oropharyngeal edema. Skin prick tests were done two months postoperatively which showed a positive reaction to neostigmine. The test was negative for other drugs used in the intraoperative period.