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Kitab Senjata Mukmin.pdf
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ndfastd2008_9698291.html · Salatul Sadia Kitab Turun (202.03A) — Kitab Senjata Mukmin: Swahili (Sub) — Kitab Senjata Mukmin: Panjabi (Urdu)
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Senjata Mukmin.pdf
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.Sir,
Modern anesthesia has evolved from ancient techniques and is thus an art. This practice has been further developed through learning, experience, and experimentation. We, hereby, report an unusual, but possible, complication of regional anesthesia in a pediatric patient, resulting in severe neurological disability.
A 5-year-old boy weighing 20 kg presented with contractures of both the hands and feet for 10 days. The contractures initially progressed within a span of few days and during this time the patient developed ‘loss of grip with chewing’ leading to severe imbalance and late presentation to the hospital. He had received multiple steroid injections at multiple institutes in the past for the same problem, but it had not helped. After the diagnosis of tetanus, central venous access (CVA) was secured and peripheral regional nerve blocks were planned on the night of admission.
Preoperatively, an intravenous access was secured in the right cubital vein using a 22-G winged needle. Using a right subclavian approach and C-arm imaging, a catheter was introduced to the right internal jugular vein (IJV) and the tip of the catheter was placed below the carotid bifurcation. After confirming the placement of the catheter at the correct location, the patient was given general anesthesia \[propofol 60 μg/kg/min and fentanyl 2 μg/kg\] and a concomitant block of the left subclavian plexus was administered through a catheter inserted subclavially, via a 22-G needle. The patient was positioned in the lateral decubitus position and a quick infusion of 1 ml of 2% xylocaine without epinephrine was given through the catheter. Loss of complete pinch grip and loss of any movement of the ipsilateral limb was observed, after which there was complete loss of sensation in the digits of the ipsilateral hand and complete loss of movement of the ipsilateral finger extensor muscles. However, there was no motor disability, and the patient was planned for the surgery.
From experience and learning, we realized that the technique used for placement of the catheter was the most likely reason for the delay in presentation to the hospital. The pre-insertion of the CVA was done with the catheter in the right IJV, and injection of bu