Conscious sedation as an anaesthetic technique in patients undergoing nonthoracotomy placement of automatic implantable cardioverter defibrillator: an initial experience

Six adult patients with life threatening recurrent ventricular arrhythmias who underwent non- thoracotomy placement of automatic implantable cardioverter defibrillator under conscious sedation are reported. Our clinical experience, patient satisfaction, recovery profile, complications and cardiologist perception about the technique of conscious sedation is presented and discussed.

Medical arthroscopy--emerging era of rheumatological intervention

OBJECTIVE

To evaluate the safety and diagnostic value of arthroscopy performed by a rheumatologist.

METHODS

Decisions for performing arthroscopy were taken when detailed clinical history-and relevant rheumatological investigations failed to arrive at a definite diagnosis. Arthroscopies were performed under local anesthesia as a daycare procedure. Synovial biopsies taken during procedures were subjected to histopathological examination (HPE).

RESULTS

Of the 50 patients enrolled, 39 were males while 11 were females with mean age of 35.5 years. In lower limb oligoarthritis group of patients, three had macroscopic picture of crystal arthropathy, rest of the 29 patients revealed gross picture indicative of non-specific synovitis. While in polyarticular group of eight patients, three had macroscopic picture suggestive of crystal arthropathy (probably polyarticlar gout) while five were indicative of rheumatoid arthritis. In monoarticular disease pattern (n= 10) macroscopic picture findings were as follows- crystal arthropathy-two, tubercular-three, synovial chondromatosis-one and non-specific synovitis-two. HPE of synovium did not correlate in many cases.

CONCLUSION

Arthroscopy using a 4 mm scope under local anesthesia in the hands of rheumatologists is a safe daycare procedure. In few cases arthroscopy helped in arriving at a final diagnosis but many patients remained undiagnosed. Both the rheumatologists and the pathologists require further experience in this field.

Personality profiles of coronary cases

Fifty coronary heart disease cases along with an equal number of controls, matched in age and educational levels were studied using Middlesex Hospital Questionnaire, Somatic Inkblot Series I and Command Hospital Questionnaire. They were between 20 and 55 years of age. Obsession and somatic personality traits measured on SIS variables were found to be statistically significant in coronary cases compared to controls. However the subject belief in the philosophy of "Karma" when measured on command hospital questionnaire did not show any difference between the two groups.