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Biomedical subjects

S Gombar

Publications and source records attributed to S Gombar.

15 recordsLinked to original sources
PubMed2005

Acute respiratory failure due to hypokalaemic muscular paralysis from renal tubular acidosis.

We report a case of hypokalaemic quadriplegia with acute respiratory failure and life-threatening cardiac arrhythmias in a 26-year-old woman who was diagnosed to have distal renal tubular acidosis. She had persistent metabolic acidosis with severe hypokalaemia and required mechanical ventilation and potassium replacement. The anaesthetic implications of renal tubular acidosis are also discussed.

Acidosis, Renal Tubular↗
PubMed1998

Anaesthetic considerations in a patient with lepromatous leprosy.

PURPOSE: To consider the anaesthetic problems in a patient with lepromatous leprosy undergoing general anaesthesia. CLINICAL FEATURES: A 52 yr old man with lepromatous leprosy for five years was booked for elective radical nephrectomy. He received 100 mg dapsone per day po. The patient was asymptomatic for cardiovascular disease but his electrocardiogram showed complete left bundle branch block, inferior wall ischaemia with echocardiogram findings of 58% ejection fraction and left ventricular diastolic dysfunction. Other preoperative investigations (haemogram, serum urea and creatinine, liver function tests and chest X-ray) were normal. After premedication with diazepam, meperidine and promethazine, the patient received glycopyrrolate and anaesthesia was induced with thiopentone. Atracurium was given to facilitate tracheal intubation. Anaesthesia was maintained with intermittent positive pressure ventilation using N2O in oxygen with halothane. Anaesthesia and surgery were uneventful except that the patient had a fixed heart rate that remained unchanged in response to administration of anticholinergic, laryngoscopy, intubation and extubation. CONCLUSION: Patients with lepromatous leprosy may have cardiovascular dysautonomia even when they are asymptomatic for cardiovascular disease.

Adjuvants, Anesthesia↗
PubMed1997

The effect of pre-operative intake of oral water and ranitidine on gastric fluid volume and pH in children undergoing elective surgery.

The effect of pre-operative intake of oral water and ranitidine on gastric fluid volume and pH was studied in 75 children of American Society of Anesthetists (ASA) grade I and grade II undergoing elective surgery. Group I patients fasted from midnight and acted as control. Group II patients received 5 ml/kg plain water orally 3 hours before surgery. Group III children received 5 ml/kg of plain water and 2 mg/kg of ranitidine orally 3 hours before surgery. Mean volume of gastric aspirate was comparable in all 3 groups (p > 0.05). Mean pH was significantly higher in ranitidine treated patients (5.12 +/- 1.73) as compared to non-ranitidine treated patients (2.26 +/- 0.57 and 2.53 +/ 0.79 in group I and group II respectively). Number of patients at risk (pH < or = 2.5 and volume > or = 0.4 ml/kg) was not significantly different in group I and group II. Mean thirst and behaviour scores were significantly higher in fluid treated patients (groups II and III) as compared to control (p < 0.01). To conclude, administration of pre-operative water (5 ml/kg) along with ranitidine (2 mg/kg) favourably modifies gastric fluid volume and pH, improves patient behaviour and minimises the number of patients at risk of aspiration pneumonitis, should the child aspirate.

Administration, Oral↗
PubMed1996

Effect of diazepam sedation on arterial oxygen saturation during esophagogastroduodenoscopy: a placebo-controlled study.

OBJECTIVE: To determine the effect of sedation using diazepam on hemoglobin oxygen saturation (SpO2) in patients undergoing esophagogastroduodenoscopy (EGD). METHOD: 100 consecutive patients scheduled for EGD were randomly allocated to receive 0.03 mL/Kg of either diazepam (5 mg/mL solution) or normal saline intravenously after topical oropharyngeal anesthesia immediately before the procedure. SpO2 was continuously monitored throughout the procedure by an anesthetist who was unaware of the drug received. RESULTS: Fall in SpO2 exceeding 4% was noted in 78% of patients in the diazepam group and in 38% of patients in the placebo group (p < 0.001). Fall in SpO2 to suboptimal level (89%) was seen in 20% of patients in the diazepam group and in 10% patients in the placebo group (p < 0.001). The duration of suboptimal SpO2 was similar (means +/- SD being 2.47 +/- 0.10 min in diazepam group and 2.86 +/- 0.32 min in placebo group). CONCLUSION: Intravenous diazepam administration before EGD produces a significant fall in SpO2 during the procedure, and so should be avoided; continuous monitoring of SpO2 should be done during EGD.

Adult↗
PubMedDate not supplied

Anatomic considerations in relation to the mandibular nerve block.

OBJECTIVES: To determine the length of needle that should be advanced beyond the distance to the lateral pterygoid plate to reach the mandibular nerve. METHODS: The study was conducted on patients and skulls. PATIENT STUDY: Distances from the skin at midpoint of the zygomatic arch to lateral pterygoid plate and to the point where mandibular nerve paraesthesia occurred were measured in 74 patients having mandibular nerve block for treatment of neuralgic pain. Osteologic study: Distances from the midpoint of the zygomatic arch to lateral pterygoid plate and to a probe inserted vertically into the foramen ovale were measured in 76 dry skulls. RESULTS: Patient study: The distance to the point where mandibular nerve paraesthesia occurred was more than that to lateral pterygoid plate by 0.07 cm on right and 0.11 cm on left. Osteologic study: The distance to the probe in the foramen ovale (representing mandibular nerve) was less than the distance to lateral pterygoid plate by 0.08 cm on the right and 0.07 cm on the left. CONCLUSIONS: There is no osteologic basis to advance the needle beyond the distance to the lateral pterygoid plate to reach mandibular nerve. However, because the needle may contact the nerve at variable points rather than the shortest distance to the nerve, the needle may be advanced by 0.07 cm on the right and 0.11 cm on the left side in patients. This increase is much less than that indicated in the standard textbooks. Therefore, while performing mandibular nerve block, we suggest caution in advancing the needle beyond the distance to lateral pterygoid plate.

Adult↗