1/6. Persistent anaphylactic reaction after induction with thiopentone and cisatracurium.A 6-year-old boy presented for surgery for phimosis. The anaesthetic technique included intravenous induction with thiopentone and neuromuscular blockade with cisatracurium. Severe persistent bronchospasm and central cyanosis followed the administration of these drugs. A continuous i.v. infusion of epinephrine at 0.2 microg. kg(-1) x min(-1) was necessary to break the severe refractory bronchial hyperresponsiveness. There was no previous exposure to anaesthetic drugs and no definite family history of allergy. Through increased serum eosinophil cationic protein, tryptase and histamine levels and IgE levels specific to cisatracurium, we demonstrated an IgE-mediated anaphylactic reaction to cisatracurium in the child's first exposure to this new neuromuscular blocking agent. Anaphylactic reactions to new anaesthetic drugs may be challenging to recognize and treat during general anaesthesia in children. The pathogenesis, diagnosis and management of life threatening persistent allergic reactions to intravenous anaesthetics are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/6. Recurrent bronchospasm during anaesthesia.Bronchospasm complicated several anaesthetics in a diabetic patient with chronic renal failure. The bronchospasm was accompanied frequently by bradycardia. The pathophysiology, treatment and implications for future anaesthetic management are discussed.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
3/6. 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) |
4/6. 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) |
5/6. 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) |
6/6. 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) |