1/9. Anaesthesia for LSCS in a morbidly obese patient.The management of a morbidly obese parturient with a body mass index of 88 is reported. She developed asthma during the pregnancy. Lumbar epidural anaesthesia was successfully used for an elective caesarean section and tubal ligation.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/9. Anaesthetic management for a patient with Dejerine-Sottas disease and asthma.Dejerine-Sottas disease is a very uncommon degenerative disease of the peripheral nervous system. The details of perioperative anaesthetic management are discussed including the use of epidural anaesthesia, with supplemental intravenous anaesthesia and an LMA.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
3/9. Reversible sensorimotor impairment following prolonged ventilation with isoflurane and vecuronium for acute severe asthma.A patient with acute asthma developed severe sensorimotor neuropathy while being ventilated with isoflurane and receiving vecuronium and fentanyl. The neuropathy resolved spontaneously within three months of the episode. This unusual complication may result from prolonged use of inhalational anaesthesia or of vecuronium, or both.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/9. hypercapnia: what is the limit in paediatric patients? A case of near-fatal asthma successfully treated by multipharmacological approach.We describe a case of prolonged severe hypercapnia with respiratory acidosis occurring during an episode of near-fatal asthma in an 8-year-old boy, followed by complete recovery. After admission to the intensive care unit, despite treatment with maximal conventional bronchodilatative therapy, the clinical picture deteriorated with evident signs of respiratory muscle fatigue. The child was sedated, intubated and mechanically ventilated. magnesium sulphate, ketamine and sevoflurane were gradually introduced together with deep sedation, curarization and continuous bronchodilatative therapy. Ten hours after admission, arterial pCO2 reached 39 kPa (293 mmHg), pH was 6.77 and pO2 8.6 kPa (65 mmHg). Chest radiograph showed severe neck subcutaneous emphysema, with signs of mediastinal emphysema. No episode of haemodynamic instability was seen despite severe prolonged hypercapnia lasting more than 14 h. Oxygenation was maintained and successful recovery followed without neurological or cardiovascular sequelae. This case shows the cardiovascular and neurological tolerance of a prolonged period of supercarbia in a paediatric patient. The most important lesson to be learned is the extreme importance of maintaining adequate tissue perfusion and oxygenation during an asthma attack. The second lesson is that when conventional bronchodilators fail, the intensivist may resort to the use of drugs such as ketamine, magnesium sulphate and inhalation anaesthesia. In this context deep sedation and curarization are important not only to improve oxygenation, but also to reduce cerebral metabolic requirements.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/9. Anaphylactoid reaction following the use of etomidate.A 13-year-old female suffered urticaria and severe bronchospasm sufficient to cause hypoxic cardiac arrest after intravenous induction of anaesthesia. etomidate was strongly implicated in the reaction. The management and mechanism of the reaction are described and discussed, together with consideration of future anaesthesia in the patient.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
6/9. bupivacaine-fentanyl epidural analgesia for a parturient in status asthmaticus.Regional anaesthesia is a suitable technique for the management of the asthmatic parturient. We report the case of an asthmatic gravida in labour in whom prompt institution of bupivacaine-fentanyl epidural analgesia was associated with enhancement of the effectiveness of concurrent medical therapy for bronchospasm. Prior to the initiation of epidural blockade, inhaled atropine was employed in an effort to reduce parasympathetic tone in the bronchial smooth muscle. Sustained clinical improvement did not occur until after delivery of the fetus and placenta.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
7/9. Anaesthesia for caesarean section in a patient with myotonic dystrophy receiving warfarin therapy.A 31-yr-old parturient with myotonic dystrophy and asthma presented for elective Caesarean section. The patient was receiving warfarin having had two previous episodes of thromboembolism. Anticoagulation was subsequently provided by heparin in the weeks prior to delivery. The combination of the patient's medical conditions and the continuing need for anticoagulation presented a considerable anaesthetic problem in planning anaesthesia and analgesia for both elective and emergency delivery. heparin was discontinued on the day prior to surgery and restarted immediately after surgery. During surgery flowtron anti-embolitic boots were used. warfarin therapy was recommenced on the seventh postoperative day. Anaesthesia for Caesarean section was provided using a combined spinal epidural technique using a separate needle, separate interspace method. Postoperative pain was relieved by using a continuous epidural infusion, transcutaneous nerve stimulation and diclofenac. No new neurological problems arose despite the use of epidural analgesia in the presence of heparin anticoagulation. This method of providing anaesthesia and postoperative analgesia without the use of opioids in an anticoagulated, asthmatic, myotonic parturient has not been described elsewhere.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
8/9. pressure support ventilation with the laryngeal mask airway: a method to manage severe reactive airway disease postoperatively.The use of a laryngeal mask airway (LMA) and a bi-level positive airway pressure (BiPAP) machine is described in a post-operative thoracotomy patient with reactive airway disease. The LMA was placed to avoid reintubation of the trachea after a double lumen tube was no longer necessary. Placement in an awakening patient and positive-pressure ventilatory support were well tolerated and did not trigger a bronchospastic response. The patient was able to cough and breathe deeply with the LMA while receiving ventilatory assistance in the post-anaesthesia care unit (PACU). The LMA is a therapeutic option to tracheal reintubation in patients who need postoperative ventilatory support after one-lung anaesthesia.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
9/9. Severe bronchospasm during epidural anaesthesia.A case of severe bronchospasm occurring during epidural anaesthesia in a patient undergoing Caesarean section is described. The aetiology of the bronchospasm may have been related to sympathetic nervous blockade allowing unopposed parasympathetically mediated bronchoconstriction.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |