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Biomedical subjects

C Ananthanarayan

Publications and source records attributed to C Ananthanarayan.

At least 19 recordsLinked to original sources
PubMed1998

General anesthesia for the provision of dental treatment to adults with developmental disability.

The management of the behavior of mentally challenged adults when providing required dental care is often a problem, whether in the dental office or in a hospital setting. Our institution has a designated program to provide required dental care to this group of patients. Because of the high incidence of poor cooperation, which may include aggressive antagonistic behavior, many of these patients are scheduled for dental care under general anesthesia with an incomplete preoperative medical assessment. The purpose of this study was to determine the impact and limitations that an incomplete medical assessment may present in the delivery of dental care under general anesthesia to these adults with developmental disability. After approval from the institutional review board, the medical records of 139 patients treated in this program between 1992 and 1994 were reviewed to determine the patient profiles, anesthesia management, and complications. The charts of these patients, who underwent dental and radiographic examination, scaling and prophylaxis, and restoration and extraction of teeth under general anesthesia, were reviewed. There were 149 procedures performed on these patients, some more than once. The mean age was 29.5 yr. Males predominated females by a ratio of 2:1. All had multiple diagnoses, medical problems, and medications. Twenty-three patients had Down's Syndrome, four had schizophrenia disorders, 42 had seizure disorders, 11 had hypothyroidism, seven had heart disease, and 14 had central nervous system and neuromuscular disorders. The remainder had a variety of diagnoses, including rare syndromes. One hundred had intravenous (i.v.), 25 had mask inhalation, and 24 had intramuscular ketamine (Ketalar) induction. Nasotracheal intubation was uneventful in 139 patients, five had difficult visualization of the larynx and intubation. Ten patients experienced intraoperative complications, including nonfatal ventricular arrhythmia, slight fall in blood pressure and hypertension (greater than 20% of preoperative value), and four individuals developed laryngospasm. In the Post Anesthetic Care Unit, five patients experienced minor airway problems resulting in a desaturation of oxygen to a level below 85%. Adults with developmental disabilities can be safely managed under general anesthesia for dental treatment in a hospital setting with minimal morbidity and without extensive preoperative investigations.

Adolescent↗
PubMed1997

Difficult intubation and brain-stem anaesthesia.

PURPOSE: To present a case of difficult intubation with brainstem anaesthesia after retrobulbar block with bupivacaine and lidocaine and sedation with midazolam and to point out that close monitoring and timely treatment is important in preventing an unfavourable outcome. CLINICAL FEATURES: An 82-yr-old man with treated hypertension and stable angina was scheduled for cataract extraction. Physical examination revealed a class 2 airway. He had a retrobulbar block after topical tetracaine drops, with bupivacaine 0.5% and lidocaine 2% with hyaluronidase under sedation with 1 mg midazolam. Five minutes after the block, respiration slowed, he became unresponsive and oxygen saturation decreased to 80%. Immediate ventilation with mask without additional oxygen improved saturation. Attempted tracheal intubation failed: the epiglottis could not be visualized despite flaccid jaw and extremities. A laryngeal mask airway was placed which was leaking and adequate ventilation could not be achieved but a second laryngeal mask airway was placed successfully. CONCLUSION: This case emphasizes the need for dose monitoring and personnel capable of managing the difficult airway when intra-orbital anaesthesia is used.

Aged↗
PubMed1996

Hysteroscopy and anaesthesia.

PURPOSE AND SOURCE: Hysteroscopy has become a widely accepted technique in the diagnosis and treatment of various gynaecological conditions. The advent of the fibreoptic endoscope and distending media has largely been responsible for the increasing use of hysteroscopy. It is our aim in this article to review the literature on the frequently used distending media such as carbon dioxide, glycine, dextran, dextrose, sorbitol and mannitol and their anaesthetic implications. PRINCIPAL FINDINGS: The endoscopist chooses the particular medium. Complications due to the distending media occur in < 4% of cases. Dilutional hyponatraemia and hypothermia are commonly encountered complications and, in addition, hyperglycaemia and volume expansion can occur. Less commonly encountered complications are embolism with carbon dioxide and pulmonary oedema, renal failure and in rare cases anaphylaxis and encephalopathy. Regional anaesthesia may offer an advantage over general anaesthesia in early recognition of fluid accumulation. Apropriate monitoring should include fluid balance, routine monitoring as well as temperature, electrolytes and blood sugar measurements. Precordial Doppler measurement, central venous and/or pulmonary artery pressure measurement may be of help in detecting as well as treating carbon dioxide and/or air embolism and fluid balance in high risk patients. CONCLUSIONS: There is no one commonly used medium and no one medium is devoid of complications. There have been no controlled studies comparing different anaesthetic techniques. Positioning of the patient can give rise to complications such as peripheral neuropathy. Hysteroscopy is a non invasive procedure which entails a short hospital course with minimal postoperative sequelae and may be cost saving.

Anesthesia↗
PubMed1996

Fiberoptic intubation using anesthetized, paralyzed, apneic patients. Results of a resident training program.

BACKGROUND: There is no consensus about the best way to teach fiberoptic intubation. This study assesses the effectiveness of a training program in which novice anesthetic residents routinely were taught fiberoptic tracheal intubation of anesthetized, paralyzed, apneic patients. METHODS: Eight inexperienced anesthetic residents learned fiberoptic and conventional tracheal intubation simultaneously during their first 4 months of training. All intubations were performed using general anesthesia and muscle paralysis. Of these intubations, 223 (23%) were fiberoptic and 743 (77%) were laryngoscopic. Subsequently, their intubation skills with the two techniques were studied in a prospective, single-blind randomized trial involving 131 elective patients. Intubation times, SpO2, ETCO2, hemodynamic changes on intubation, and complications were recorded for 71 fiberoptic and 57 laryngoscopic intubations. RESULTS: There were two failures of the rigid and one failure of the fiberoptic technique due to inability to intubate within 180 s. In cases of failure, the tracheas were intubated successfully after mask ventilation by the alterative technique. No hypoxemia or hypercarbia occurred in any patient. There were no differences in hemodynamic indexes nor incidence of sore throat or hoarseness between the two groups. Mean intubation times were 56 +/- 24 s (mean +/- SD) for fiberoptic and 34 +/- 10 s (mean +/- SD) for laryngoscopic (P < 0.001). CONCLUSIONS: Novices taught fiberoptic intubation and rigid laryngoscopic intubation under similar conditions, with similar volumes of experience, learn both techniques well. The safety and effectiveness of this training regimen commend it for inclusion in any residency program.

Adult↗
PubMed1995

Alternating nitroglycerin and syntocinon to facilitate uterine exploration and removal of an adherent placenta.

Nitroglycerin (NTG) has been demonstrated to provide uterine relaxation in the management of various obstetric complications. A 32-yr-old woman presented 40 min postpartum for manual removal of a retained placenta. Repeated, alternating doses of NTG 250 micrograms and syntocinon (SYN) 10U iv were used over 15 min to produce periods of uterine relaxation and contraction respectively for uterine exploration. Multiple attempts to extract the placenta failed and a diagnosis of placenta accreta was made. There were no major side effects from this combination of drugs apart from a transient 20% decrease in blood pressure after NTG, which responded to ephedrine 10-15 mg iv. The rapid change in uterine tone was believed to be due not only to the short duration of action of NTG and SYN, but also to the possible physiological antagonism between the two drugs. The mechanism of interaction may involve calcium mobilization and myosin light chain phosphorylation. We conclude that NTG and SYN can be used to produce alternating periods of uterine relaxation and contraction rapidly and consistently with little sustained effects from either agents.

Adult↗
PubMed1994

Dacryocystorhinostomy in elderly patients: regional anesthesia without cocaine.

Elderly patients with nasolacrimal obstruction who are in poor health often pose a special anesthetic and surgical risk. General anesthesia and the use of cocaine packs may be contraindicated because of potentially dangerous side effects. Regional block dacryocystorhinostomy has gained popularity in all adult patient groups, but specifically it appears to be the procedure of choice in elderly patients. It is well suited for either hospital-based or ambulatory care. We describe our experience with the procedure in 25 consecutive patients (28 procedures), with emphasis on modification of our standard technique to suit regional blockade. Mechanisms of cocaine toxicity in the surgical setting are reviewed, and a method of local anesthesia without cocaine nasal packing is presented.

Aged↗
PubMed1991

TURP syndrome.

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Anesthesia, Spinal↗