1/10. Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report.BACKGROUND: The short term experience of endovascular treatment of abdominal aortic aneurysms (AAA) seems promising but long term randomised data are lacking. Consequently, cases treated by endovascular procedures need to be closely followed for potential risks and benefits. CASE REPORT: A 70 year-old mildly hypertensive male without previous or present arteriosclerotic, pulmonary, or urological manifestations was subjected to endovascular treatment after his mass-screening diagnosed abdominal aortic aneurysm had expanded to above 5 cm in diameter, the aneurysm having been found by CT-scanning and arteriography to be endovascularly treatable. A Vanguard bifurcated aortic stent graft was implanted under epidural/spinal anaesthesia and covered by cephalosporine and heparin (8000 IE) protection. Apart from treatment of a groin haematoma and stenosis of the left superficial femoral artery, the postoperative period presented no problems. A few days before the monthly follow-up visit, the patient developed uraemia, gangrene of one foot and dyspnoea. blood glucose and LDH was elevated. Deterioration led to death a month and a half after stent implantation. autopsy showed extraordinary large, extensive soft, brown vegetations in the lower part of the thoracic aorta above the properly infrarenally-placed stent. Microscopic examination revealed multiple microemboli in the liver, spleen, pancreas, intestines, testes, and especially the kidneys. DISCUSSION: Early death from microemboli after aortic stent implantation has been reported. However, the present case developed fatal multiple microemboli so late that they could not have originated from the excluded mural thrombus. The sudden death of an otherwise healthy man of extensive microemboli is difficult to explain. The stent application may have altered the proximal flow and wall movements disposing to microemboli in the case of vegetations.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/10. 'Shared spinal cord' scenario: paraplegia following abdominal aortic surgery under combined general and epidural anaesthesia.Serious neurological complications of abdominal aortic vascular surgery are rare but devastating for all involved. When epidural blockade is part of the anaesthetic technique such complications may be attributed to needles, catheters or drugs. We present a patient who developed paraplegia following an elective abdominal aortic aneurysm repair. Continuous epidural blockade was part of the anaesthetic technique and postoperative analgesia. In this case the spinal cord damage was explained by ischaemia caused by the aortic surgery. This event has made us aware of a rare complication associated with abdominal aortic surgery and highlighted safety aspects of epidural anaesthesia in such patients.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
3/10. Continuous spinal anaesthesia/analgesia for abdominal aortic aneurysm repair and post-operative pain management.The intra-operative management of two patients with chronic obstructive pulmonary disease and cardiovascular pathology, who underwent peripheral reconstructive vascular surgery under continuous spinal anaesthesia, is described. Furthermore, continuous intrathecal analgesia was also continued in the post-operative period and provided effective pain relief that was reflected by the favourable surgical outcome.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
4/10. Pitfalls in surgical resuscitation.Timing of diagnosis and intervention, together with understanding of physiology and knowledge of anatomy, are essential for success in the practice of surgery in general, and emergency surgery in particular. Either excess of treatment, for example fluid overload in tamponated haemorrhage such as a ruptured retroperitoneal Abdominal aortic aneurysm, or defect of treatment such as delayed arrest of life threatening bleeding from a transected Superficial femoral artery above the knee, can both lead to disastrous outcome or death. Proximal control of damaged arteries is an obligatory step before repair and in emergency situations must be effected rapidly: the femoral artery can be easily aggressed at the groin under local anaesthesia; the abdominal aorta can be rapidly controlled with digital compression at the hiatus through the avascular area of the gastrohepatic ligament.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/10. Case report: Endovascular repair of a ruptured abdominal aortic aneurysm under local anaesthesia.Abdominal aortic aneurysm (AAA) is a common degenerative condition affecting the elderly population. rupture carries a high overall mortality. Elective endovascular stent graft repair is well described. We describe a patient with ruptured AAA and co-morbid conditions making him unfit for surgery and general or epidural anaesthesia, who was successfully treated by endovascular stent graft under local anaesthesia.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |
6/10. 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) |
7/10. Repeated episodes of myocardial ischaemia during combined thoracic epidural-isoflurane anaesthesia.A patient with a history of coronary artery diseases developed new ST segment depressions in the ECG registration during a low dose (0.7%) isoflurane anaesthesia that was combined with a continuous thoracic epidural analgesia. Simultaneously a small decrease in mean arterial blood pressure (MAP) was noted. During the next 5 min these changes were followed by a severe drop in MAP (from 88 to 60 mmHg) and in cardiac output from 5.5 to 3.2 L/min. When isoflurane was discontinued both the ECG and the cardiovascular changes returned to the previous condition. Later, when 0.5% isoflurane was restarted, the ECG changes reappeared within ten min, but disappeared once again when isoflurane administration was discontinued. Thus, this patient had repeated episodes of myocardial ischaemia which were associated with the use of low dose isoflurane. Although isoflurane-induced "coronary steal" may appear as a likely cause of these ischaemic episodes, it is possible that the thoracic epidural had synergistic action and rendered the patient exceptionally sensitive to minor changes in perfusion pressure.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
8/10. aortic aneurysm in a four-year-old child with tuberous sclerosis.We present a case of aortic aneurysm in a four-year-old child complicated with tuberous sclerosis. We used the same general principles as for adult patients and successfully managed our patient. Our methods included the use of isoflurane plus epidural anaesthesia, dopamine to maintain blood pressure, and induced mild hypothermia to reduce brain metabolism and to prevent spinal cord damage during aortic cross-clamping. Intensive monitoring including EEG was beneficial to the anaesthetic management.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
9/10. Lumbosacral plexopathy from iliopsoas haematoma after combined general-epidural anaesthesia for abdominal aneurysmectomy.PURPOSE: To report a case of iliopsoas haematoma after resection of an abdominal aortic aneurysm which resulted in a lumbosacral plexopathy. CLINICAL FEATURES: An 81-yr-old man presented with an abdominal aortic aneurysm for aneurysmectomy and tube grafting. An epidural catheter was placed at the L1-2 spinal level and combined epidural-general anaesthesia was provided for surgery. The surgery was complex and a suprarenal clamp was necessary to obtain proximal control. A continuous infusion of demerol through the epidural catheter was prescribed for postoperative analgesia. On the first postoperative day, examination revealed a paretic, pulseless right leg and he was returned to the operating room for femoral-femoral bypass. By the following day, the motor and sensory impairment had progressed to complete paralysis with loss of all deep tendon reflexes and absent sensation below L1, despite palpable pulses in the leg. A CT of the abdomen demonstrated a right iliopsoas haematoma. There was no evidence of either disc herniation or an epidural haematoma. A diagnosis of lumbosacral plexopathy secondary to a iliopsoas haematoma was made. CONCLUSION: Iliopsoas haematoma is a rare cause of postoperative neurological deficit following aortic vascular surgery. The haematoma results in compression of the lumbosacral neural elements and typically presents as a femoral neuropathy. The diagnosis is clinical and can be readily validated with computed tomography.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
10/10. Treatment of milrinone-associated tachycardia with beta-blockers.PURPOSE: To describe a case of milrinone-associated tachycardia that was successfully treated with two beta-blockers. CLINICAL FEATURES: A 74-yr-old male patient underwent elective abdominal aortic aneurysm repair under combined epidural/general anaesthesia. He had a history of alcohol abuse, controlled hypertension and ischaemic heart disease. Postoperatively, the patient had persistent sinus tachycardia that was initially unsuccessfully treated with metoprolol. Subsequently, the patient's blood pressure and cardiac index decreased with an associated increase in pulmonary artery pressure. Analysis of the ST-segment revealed no evidence of myocardial ischaemia or infarction. These haemodynamic changes were treated with milrinone which exacerbated the baseline tachycardia without adverse blood pressure response. The subsequent administration of beta-blockers (esmolol and metoprolol) was successful in controlling the heart rate response to milrinone without adversely affecting the patient's haemodynamic profile. CONCLUSION: This report demonstrates the efficacy of esmolol and metoprolol for the treatment of milrinone-associated tachycardia, without compromising the haemodynamic effects of milrinone.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
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