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All Journal Bali Journal of Anesthesiology
Govil, Nishith
DiscoverSys Inc.
Health Professions Medicine & Pharmacology Other

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ANAESTHETIC MANAGEMENT OF EXTRAHEPATIC PORTAL VENOUS OBSTRUCTION Govil, Nishith; Chandra, Nilesh; Ghosh, Surjyendu; Dhar, Mridul; Ahmed, Intezar
Bali Journal of Anesthesiology Vol 2, No 3 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (173.3 KB) | DOI: 10.15562/bjoa.v2i3.103

Abstract

Extrahepatic portal venous obstruction (EHPVO) is the commonest cause of portal hypertension and variceal bleeding in children. Major concerns are growth retardation, decrease lean body mass and loss of muscle that may lead to postoperative respiratory failure. Upper abdominal surgery with severe pain may compound the problem of pulmonary atelectasis. Poor preoperative nutritional status and anemia may lead to delayed wound healing, delayed ambulation, and respiratory complications. To avoid postoperative respiratory complications and surgical site infection we inserted epidural catheter despite the possibility of intraepidural space bleed due to low platelet counts. The patient had an excellent recovery profile in term of analgesia, decrease postoperative nausea and vomiting due to decrease consumption of opioids, increase sedation-free period, early ambulation and parent’s satisfaction. The intraoperative epidural also provides better abdominal muscle relaxation, wider surgical bloodless field and optimal pressure in anastomosis vessels. Regional techniques are avoided in thrombocytopenia, but risk and benefits must be assessed in each case.
DIFFICULT MASK VENTILATION RESCUED BY A PEDIATRIC FACEMASK Govil, Nishith; Singh, Girish Kumar; Chandra, Prakash; Ittoop, Amanta Lucy
Bali Journal of Anesthesiology Vol 2, No 3 (2018)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (123.476 KB) | DOI: 10.15562/bjoa.v2i3.101

Abstract

Anesthetic challenges arises in securing airway due to difficult mask ventilation because of obstructed nasal passage and unanticipated intraoral extension by a tumour mass leading to difficult intubation also. This sometime lead to the dreaded path of “Cannot Intubate & Cannot Ventilate”. We are describing a successfully managed case of ossifying fibroma arising from the maxilla causing difficulty in ventilation with the help of pediatric circular facemask and airway.
Co-Authors Ahmed, Intezar Chandra, Nilesh Chandra, Prakash Dhar, Mridul Ghosh, Surjyendu Ittoop, Amanta Lucy Singh, Girish Kumar