Critical Cases

March

1.    Juvenile Recurrent Laryngeal Paillomatosis- A 4 year old boy is undergoing multiple procedures for CO 2 LASER vaporization of recurrent Laryngeal Papillomas.

2.    Total Thyroidectomy in a patient with large artic Aneurysm- A middle aged lady with large thoracic aortie aneurysm was posted for Total Thyroidectomy.
She was operated at a cardiac centre due to risk of rupture of aneurysm. The surgery was conducted uneventful.

3.    Subglottic Web- A 2 ½ year old girl came with history of meningoencephalitis when she was intubated and ventilated for prolonged period. Subsequently she developed a web in subglottic region. She had dyspnea with slightest exertion and was admitted two weeks back in stridor at another hospital with conservative management the patient was slightly better and she was referred to Dr. Madan Kapre.
CT scan of the child showed that in subglottic region her tracheal diameter was only 2.4 mm. Anesthesing and securing airway was risky due to possibility of airway obstruction and difficulty in introducing even 2.5 endotrachal tube.
The child was gradually induced with IV glycopyrnolate, fentanyl, propofol and O2, N2O and sevoflorane.
2.5 mm red rubber uncuffed endotracheal tube with stiletto could be introduced. 
The risk during LASER vaporization of the web was that sina the tube was uncuffed, there would be free O2 enriched gases in the larynx. As the tracheal lumen was very narrow there was no space for covering the endotracheal tube to prevent LASER punction. To ivercome these difficulties, just before Laserisation the endotracheal tube was disconnected from anaesthesia circuit. During Laserisation the endotracheal tube contained only air, so the risk of tube puncture and airway fire was minimized.
The web was successfully vaporized with CO 2 LASER and adequate tracheal lumen achieved. Subsequrently 4 mm endotracheal tube could be introduced easily. The patient made good recovery.

4.    Bilateral abduction Palsy in young child – A 7 year old girl came with history of head injury followed y frontal lobe syndrome requiring long term intubation and ventilation.. The child developed bilateral abduction and palsy leading to stridor and had to be tracheostomised.

5.    Kashima procedure was done using CO2 LASER. Adequate laryngeal inlet was achieved. On subsequent visit airway assessment will be done and if the laryngeal inlet remains adequate, the tracheostomy tube can be removed.

6.    Extensive thyroid malignancy with extranodal spread & nodes stuck to common carotid RLN & esophagus – underwent successful Total Thyroidectomy & Neck Clearance with Complete Clearance.


February 

1.    Juvenile Recurrent Laryngeal Paillomatosis- A child with recurrent laryngeal papillomatosis is undergoing treatment with multiple sittings of CO2 LASER vaporization. His larynx is now clear, but there are subglottic pailloma which have to be removed with cold steel instruments through the tracheostome.
2.    Botox injection done for spasmodic Dysphonic- Injection of botulinum toxic into the vocal folds was done in two patients of spasmodic dysphonia. This procedure was done under local anaesthesia with EMG guidance and for the other patient was done under general anaesthesia.
This procedure was done for the first time in Nagpur. Previously such procedures were only being done in one centre Mumbai and one centre Pune in Maharashtra. 
3.    CSF Leak Repair- CSF leak in a middle aged lady was repaired endoscopically with fascia lata and surgical glue.
4.    Nasopharyngeal Angiofibroma – A young boy presented with Nasopharyngeal Angiofibroma. Patient was operated after embolisation and blood loss was minimal.

January

1.    CSF Leak Repair- CSF leak from cribriform plate was repaired endoscopically in a middle aged lady. The leak was sealed with fascia lata graft and medical glue.


2.    Tracheal Stenosis- A young girl had tracheal stenosis post ventilation after suicidal attempt. She had undergone tracheostomy due to the narrow airway. CO2 LASER vaporization of the stenosis was done in 2 sittings. Further endoscopy revealed normal patent airway, so the tracheostomy tube could be removed and patient decannulated successfully. 


3.    Cochlear Implant Surgery- was performed on a 2 year old child who had profound sensorineural hearing loss. Dr. Harsh performed the surgery under the guidance of Dr. M.V. Kirtane and helped by Dr. Gauri.  

 

 

December

1.    Awake Blind Nasal Intubation A adult male patient had undergone Hemimandibulectomy several year back. He came for excision of CA Buccal Mucosa. Patient has also developed Trismus. Local Anaesthesia of the airway was achieved by Bilateral Superior Laryngeal Nerve Blocks. Transtracheal local anesthetic injections and Nebulisation with local anesthetic. The mouth opening was severely restricted and would not even admit magill forceps. So awake Blind Nasal Intubation was performed

 

2.      Rare tumour in Parapharyngeal Space- A middle aged lady had a rare tumor ( lipoepithelioma) in the neck. Major arteries were passing through the tumors hence the surgery was high risk. Patient also had strongly positive stress test so she was operated at Dr. Tambe’s critical care unit.
 

3.    Supraventricular Tachycardia- A male patient with no co – morbidities was to be operated for ca Tongue. After intubation, patient had severe tachycardia in the range of 160/min which persisted even after administration of  beta blocker and IV xylocard after consultation with cardiologist, surgery was postponed, patient awakened. Later a thorough cardiac evalution was done, patient  was given Tab Diltiazem and operated after 5 days uneventfully 

 

November

  1. Free Radial Artery Forearm Flap- was done for a patient operated for Ca Buccal Mucosa.
  2. Endoscopic CSF leak repair- was done for a middle aged lady patient.
  3. Antero lateral Thigh Flap- was done in a patient after excision of Ca Alveolus.