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. Myocardial ischaemia precipitated by acute normovolaemic haemodilution.Acute normovolaemic haemodilution (ANH) is widely used as part of a blood conservation strategy to minimize the use of allogenic blood in the peri-operative period. Its role has not been proven in a prospective randomized trial. The potential benefits must not blind clinicians to the possible hazards. We report a life-threatening complication of ANH prior to induction of anaesthesia for aortic aneurysm repair.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/7. 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) |
4/7. Delayed presentation of an extradural abscess complicating thoracic extradural analgesia.Extradural abscess is a rare but recognized complication of extradural anaesthesia. Previous reports have been associated with a short time interval between extradural catheterization and presentation. We report a patient with rheumatoid arthritis, receiving steroid therapy, in whom an extradural abscess did not present until 23 days after the insertion of a thoracic extradural catheter to provide postoperative analgesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/7. Mycotic thoracic aortic aneurysm producing vertebral body destruction and paraplegia: case report.In the surgical treatment of an aortic aneurysm, disruption of the blood supply to the spinal cord, resulting in paraplegia and anaesthesia below the level of involvement, is a dreaded complication. Occasionally, when an aortic aneurysm compresses a major vessel that supplies the anterior spinal artery, spinal cord ischaemia and paraplegia can occur before surgery. In the case presented here, however, preoperative paraplegia appears to have resulted from direct spinal destruction by an infected aortic aneurysm that was originally diagnosed as a spinal abscess. The patient underwent operative repair, but her aorta was so friable that the sutures would not hold. Despite repeat surgery, her condition rapidly proved fatal. This case shows that, in patients with a suspected spinal abscess, computer tomographic scanning and angiography should be performed to confirm the diagnosis and to rule out other pathological conditions. An accurate pre-operative diagnosis will permit adequate operative planning and prevent catastrophic results.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
6/7. 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) |
7/7. 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) |