1/6. Delivery of an hypoxic gas mixture due to a defective rubber seal of a flowmeter control tube.The delivery of an hypoxic gas mixture to a patient during general anaesthesia is a rare event due to contemporary standards of monitoring, equipment design and alarm features. An incident is described where a split occurred in a rubber seal round the top of a flowmeter control tube. This resulted in a downstream oxygen leak and the delivery of an hypoxic gas mixture to the patient. The bobbin on the oxygen flowmeter did not accurately reflect the amount of oxygen being delivered. A paramagnetic oxygen analyser and a fuel cell oxygen electrode indicated that the inspired oxygen concentration was lower than intended. The anaesthetic machine was exchanged, and the operation continued uneventfully. The faulty anaesthetic machine subsequently passed a formal pressure test by the hospital engineers and also close examination of the flowmeter control valves. The importance of monitoring equipment and the interpretation of the information that they provide is emphasized.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/6. Intraoperative death during caesarian section in a patient with sickle-cell trait. The Anaesthesia Advisory Committee to the Chief Coroner of ontario.The case of a woman with sickle cell trait who sustained a cardiac arrest and died during a Caesarian section under general anaesthesia is reported. Because the common causes of intraoperative hypoxia and shock were ruled out in this case, we believe that death was due to severe concealed aorto-caval compression. After delivery, the release of a large volume of hypoxaemic, acidotic blood with sickled cells could cause cardiac depression and arrest. The fact that the patient's mucous membranes were pink and she was haemodynamically stable while her uterus was cyanotic prior to delivery provides some positive evidence for this hypothesis. We emphasize that while complications secondary to sickle cell trait during general anaesthesia are very rare, they can occur. We discuss methods of monitoring such patients.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
3/6. Infundibular spasm in Fallot's tetralogy - an account and its management in anaesthesia.The value of propranolol in relieving infundibular spasm is illustrated. The pathophysiology of infundibular spasm in Fallot's tetralogy and its management in anaesthesia is reviewed.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
4/6. A rare cause of intra-operative hypoxaemia.A 25-year-old man underwent left inguinal hernia repair. Following induction of anaesthesia, desaturation below 90% was noted which persisted despite correct placement of an endotracheal tube and ventilation with 100% oxygen. Surgery was allowed to continue, and the suspected diagnosis of pulmonary arterio-venous malformation was confirmed post-operatively by computerized axial tomography and arteriography. The investigation and treatment are described, and the diagnostic value of pulse oximetry in this case is emphasized.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/6. Mechanical obstruction in the anaesthesia delivery-system mimicking severe bronchospasm.We present a case where mechanical obstruction in the anaesthesia delivery system caused by plastic wrapping from a filter was misinterpreted as severe bronchospasm. The patient suffered severe hypoxia before the problem was solved by using a free-standing self-expanding ventilation bag. This near-fatal incident emphasises the importance of thorough equipment checking routines, rapid troubleshooting and how equipment failure may be misinterpreted as a medical complication. It also shows how transparent container material can become a medical hazard.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
6/6. Difficult airway in a patient with Marshall-Smith syndrome.Marshall-Smith syndrome is a rare clinical disorder characterized by accelerated bone maturation, dysmorphic facial features, airway abnormalities and death in early infancy because of respiratory complications. Although patients with Marshall-Smith syndrome have several features with potential anaesthetic problems, previous reports about anaesthetic management of these patients do not exist. We present a case, in which severe hypoxia developed rapidly after routine anaesthesia induction in an eight-month-old male infant with this syndrome. After several unsuccessful attempts the airway was finally secured by blind oral intubation. After 2 weeks, laryngeal anatomy was examined with fibreoptic laryngoscopy which revealed significant laryngomalacia. laryngoscopy was performed without problems with ketamine anaesthesia and spontaneous breathing. The possibility of a compromised airway should always be borne in mind when anaesthetizing patients with Marshall-Smith syndrome. Anaesthesia maintaining spontaneous breathing is safest for children with this syndrome. If tracheal intubation or muscle relaxation is required, precautions are needed to maintain a patent airway. Muscle relaxants should possibly be avoided before intubation.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |