1/3. A technique of anaesthesia in haemorrhagic shock. Illustrative case histories and a discussion.The anaesthetic management of patients in haemorrhagic shock is described. The principles are those of initial resuscitation with electrolyte solutions and alleviation of metabolic acidosis, combined with early induction of anaesthesia to permit control of bleeding as soon as possible. The anaesthetic technique depends on pre-oxygenation, intravenous anaesthesia, muscular relaxation and ventilation with pure oxygen. Earlier cases were induced with thiopentone and maintained with intermittent suxamethonium, but intravenous ketamine was later employed for induction and intramuscular ketamine for maintenance; this use of ketamine is now the author's method of choice. The use of a central venous pressure line connected to a cannula in the internal jugular vein is recommended.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Short-term low-dose propofol anaesthesia associated with severe metabolic acidosis.propofol-induced metabolic acidosis is well recognised in the paediatric literature, but the existence of such a syndrome in adults remains contentious. In most reported cases, metabolic acidosis complicated prolonged administration of propofol in critically ill patients. We present a case of severe non-fatal reversible metabolic acidosis, without ventilatory depression or hypoxia, related to short-term propofol infusion in an adult during and after coronary artery bypass grafting. We suggest that lactic acidosis occurred in a genetically susceptible patient with an abnormality of mitochondrial function. This report discusses an unusual adverse effect of propofol anaesthesia and sedation and highlights the need for further investigation to define propofol toxicity.- - - - - - - - - - ranking = 0.83333333333333keywords = anaesthesia (Clic here for more details about this article) |
3/3. Anaesthesia and pyruvate dehydrogenase deficiency.A ten-month-old infant with pyruvate dehydrogenase deficiency received anaesthesia on two occasions, once for a laparotomy and once for a tracheostomy. During both anaesthetics (different techniques) she developed an increase in arterial lactate levels and a metabolic acidosis. Pyruvate dehydrogenase deficiency results in the inability to metabolize pyruvate with resultant accumulation of pyruvate and lactate. Inhibition of gluconeogenesis, which may be produced by halothane and thiopentone, will also increase lactate levels. Other causes of increased lactate levels are hypocarbia and high carbohydrate intake. In this patient hypocarbia may have produced increased lactate levels and increased the metabolic acidosis. Recommendations include avoidance of halogenated anaesthetics, avoidance of lactate containing solutions, maintenance of normocarbia, and stress-free anaesthesia.- - - - - - - - - - ranking = 0.33333333333333keywords = anaesthesia (Clic here for more details about this article) |