1/7. Emergency repair of incidentally diagnosed ascending aortic aneurysm immediately after caesarean section.A 36-yr-old pregnant woman with a history of hypertension presented at term for elective Caesarean section because of breech position. At preoperative examination, a diastolic murmur was found and transoesophageal echocardiography (TOE) revealed a large, 8.1-cm diameter ascending aortic aneurysm with severe aortic regurgitation and moderate pericardial effusion. Surgical repair was not considered to be urgently required. The patient was delivered electively by Caesarean section under epidural anaesthesia using invasive arterial pressure monitoring. TOE performed 6 h post-partum showed progressing pericardial effusion, for which emergency replacement of the aortic valve and ascending aorta were indicated. The epidural catheter was removed 4 h before starting the cardiopulmonary bypass procedure. arterial pressure was controlled by a titrated infusion of esmolol and clonidine. To improve uterine tone, the patient received an i.v. infusion of oxytocin throughout surgery. After implantation of an aortic composite graft and weaning from cardiopulmonary bypass, the patient was transferred to the intensive care unit. Awake and receptive to neurological evaluation, her trachea was extubated 4 h after surgery. Mother and baby made an uneventful recovery.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/7. anterior spinal artery syndrome complicating aortic dissecting aneurysm: case report.spinal cord ischaemia is rare in the absence of trauma. We report a case of a 45 year old known hypertensive for six years, who presented with features of anterior spinal artery syndrome (ASAS) complicating acute dissection of the descending aorta. He developed sudden onset non-traumatic paraparesis, sphincteric dysfunction and dissociated anaesthesia with a sensory level at T6. This was preceded by a two weeks' history of severe, sharp, lancinating, tearing left parasternal chest pain radiating to the back. He was managed conservatively on pentazocine lactate (fortwin), calcium- and beta-blockers, steroids, anti-platelet and free-radical scavengers. On the 8th day of hospitalisation, he had a sudden abdominal distension, bled from the nose and mouth, went into hypovolaemic shock and died within a time frame of two minutes. He was presumed to have had a progression of the aortic dissection with subsequent rupture. Dissecting aortic aneurysm could run a benign asymptomatic or a lethal course and a high index of suspicion is necessary. The lack of exhaustive diagnostic investigative tools as well as surgical intervention in the management of this patient in a developing country was highlighted as was possible that the patient could have been mismanaged.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/7. Backache after extradural anaesthesia in the postpartum period: dissection of thoracic aneurysm.We describe a case of postpartum ruptured dissecting aneurysm of the thoracic aorta, unrelated to the anaesthetic management with extradural anaesthesia. This complication is discussed in detail, as the anaesthetist may be the specialist required to respond to the common presenting symptom of severe back pain.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
4/7. dissection of ascending thoracic aorta complicated by cardiac tamponade.Two cases of cardiac tamponade caused by dissections of the ascending thoracic aorta are described. Despite uneventful induction of anaesthesia one patient exsanguinated following sternotomy and release of pericardial tamponade as the resulting increase in blood pressure caused aortic rupture. The second patient was managed with femoral-femoral bypass, propranolol and vasodilators prior to sternotomy to avoid this complication, and he survived. The anaesthetic management of a patient with cardiac tamponade is directed towards maintaining cardiac filling pressures and contractility. When the tamponade is released the sudden increase in cardiac output and blood pressure may cause the already weakened aorta to rupture.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/7. cardiac tamponade complicating anaesthetic induction for repair of ascending aorta dissection.A case is described of a 69-year-old woman with dissection of the ascending aorta who developed cardiac tamponade during induction of anaesthesia. The tamponade was diagnosed by a haemodynamic profile showing approximation of the central venous, pulmonary wedge and pulmonary arterial diastolic pressures, and was treated with rapid surgical intervention and drainage of the haemopericardium. cardiac tamponade and dissecting aneurysms of the ascending aorta are conditions with contrasting anaesthetic considerations and the problems encountered are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
6/7. pregnancy complicated by aortic dissection: caesarean delivery during extradural anaesthesia.We report a case where dissection of the aorta occurred in pregnancy; only medical management was undertaken. Delivery was by Caesarean section during extradural anaesthesia and was accomplished safely several weeks after the dissection. The aetiology, association with pregnancy, diagnosis and management of acute dissection of the aorta are discussed.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
7/7. Multiple coronary artery dissections in a woman at term.We report a case of acute myocardial infarction caused by multiple coronary artery dissections in a pregnant woman at term. When reinfarction elicited fetal distress, Caesarean section was performed under carefully administered extradural anaesthesia, with maternal and fetal survival.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |