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Introduction: A bulla is defined as an intraparenchymal air-filled space of more than 2 cm in diameter in distended state within the lung which has developed because of emphysematous destruction of the lung parenchyma and loss of alveolar structural tissue. Indications for surgical resection of bullae include incapacitating dyspnea, a large bulla that fills >30% of the hemithorax, as seen in this case. Patients with Lung emphysematous bulla are at increased perioperative risk of rupture & barotrauma resulting in tension pneumothorax & compromised respiratory status. After a meticulous clinical and radiological assessment, patients with bullae can be taken up for surgeries like local excision/bullectomy, lobectomy, segmental resection, and minimal access surgeries. Case Report: We present an atypical case of a 26-year-old female with a large bulla measuring 16 x 21 x17cm arising from left lower lobe with centrilobular emphysema with passive collapse of left upper lobe and gross mediastinal shift to the right, managed successfully using lung isolation technique and peri-operative pain management. Conclusion: Anaesthetic management of a patient with lung bulla is challenging. Anesthesiologist should deliberate over an extensive preoperative assessment to identify the high-risk factors, reversibility of underlying lung pathology, need and dependency on mechanical ventilation, and establish a successful perioperative management plan for a smooth, pain free post-operative recovery in such patients. In this case, we describe the anaesthetic considerations of a patient with multiple large lung bullae underwent elective bullectomy under general anaesthesia. No serious complications occurred during intraoperative and postoperative course. [ABSTRACT FROM AUTHOR]

Introduction: Mycobacterium Tuberculosis remains a major cause of morbidity and mortality in India. Emergence of new strain of Mycobacterium tuberculosis that is highly resistant to current antibiotics has been evolved and is a main concern. Currently, Multidrug-resistant (MDR) and Extensive drug-resistant (XDR) Tuberculosis (TB) are significant health problems in India. Main treatment being medical, surgical resection may increase chance of cure in selected cases. Combined medical and surgical approaches are increasingly being used for treatment of MDR-TB and XDR-TB. Medical management include consumption of Antitubercular drugs (AKT) whereas, Lobectomy is a surgical procedure in which diseased or non-functional part of a lung is removed, so that the remaining healthy lung tissue can work normally. As compared to adults, paediatric population have some anatomical and physiological characteristics that makes them susceptible to postoperative complications after open thoracic surgery. Case Report: We present a case of 10year old male patient posted for Lobectomy as a surgical treatment combined with anti-tubercular drugs for the management of MDR-TB with the successful combination of endotracheal tube and prone position, which provided adequate ventilation and oxygenation without complications. Conclusion: Surgery remains an important adjunct to medical therapy for the treatment of MDR-TB. In the view of persistent sputum positivity and intolerance of medical therapy, surgical intervention such as lobectomy or segmentectomy or pneumonectomy, should be considered. [ABSTRACT FROM AUTHOR]

Byline: Vaishali. Mohod, Bharati. Kondwilkar, Rohit. Jadoun Background and Aims: Brain death is defined as irreversible and complete cessation of all brain function including that of the brainstem. The aim [...]

Foreign body (FB) in tracheobronchial tree is a serious and potentially fatal condition in all age groups. Early diagnosis and removal are imperative to prevent mortality as well as complications. A 45 year old heroine (diamorphine) addict was brought to the emergency department in a gasping state, with a history of substance abuse. The patient was intubated with Portex® cuffed endotracheal tube No. 8 and was shifted to intensive care unit for ventilation. Follow up x-ray chest revealed a metallic wire like FB in the bronchus. In the operating room, rigid bronchoscopy under general anesthesia failed to remove FB. Fibreoptic bronchoscope revealed an intubation stylet below carina. Subsequent attempts were unsuccessful so tracheostomy was done and the stylet was removed through tracheal stoma under fibreoptic visualization. The ventilation strategies used being ventilating bronchoscope, intermittent mask ventilation and intubation twice. [ABSTRACT FROM AUTHOR]

The study was conducted to compare the efficacy and safety of topical application of purified extract of human placenta (placentrex gel) versus povidone iodine for its wound healing potential after orthopaedic surgeries. In this open, comparative, randomised study, 79 patients above 18 years of age undergoing elective clean and uncontaminated orthopaedic surgery (open fracture reduction, spine surgery and debridement of wound) were enrolled in the study after obtaining written informed consent. Enrolled patients were randomised as per the PC generated randomisation chart (Rando 1.2, 2004) to receive either topical application of human placenta purified extract (PE) on the surgical wound or topical application of povidone iodine (PI) ointment on the surgical wound. Both preparations were applied topically on the surgical wound after the surgery, on days 3, 7 and on day 10, if required. Assessment of surgical wound was done after recovery from anaesthesia and on days 3, 7 and 10 based upon wound healing, physicians' global assessment of response to therapy (PGART) scale, pain and adverse effects. All 79 patients (40 PE and 39 PI) completed the study on day 10 as per the study protocol. Healing of the wound was observed in all patients. The number of patients reporting pain on days 3, 7 and 10 were similar in both PE and PI treatment (p, 0.527) groups. Wound induration was observed in 6 patients (15.00%) of PE and 15 (38.46%) of PI on day 7 (p, 0.041). None of the patients reported any side/adverse events during the study period. Purified placental extract and povidone iodine have comparative wound healing effects.