1/13. Target-controlled intravenous anaesthesia with bispectral index monitoring for thoracotomy in a patient with severely impaired left ventricular function.The anaesthetic management of an elderly patient with severely impaired left ventricular function undergoing thoracotomy and lobectomy is described. Total intravenous anaesthesia (TIVA) with remifentanil and target-controlled infusion of propofol titrated according to the bispectral index (BIS) was used, with thoracic epidural anaesthesia commenced at the end of surgery providing postoperative analgesia. Avoidance of intraoperative epidural local anaesthetics and careful titration and dose reduction of propofol using the BIS was associated with excellent haemodynamic stability. The rapid offset of action of remifentanil and low-dose propofol facilitated early recovery and tracheal extubation. The BIS was a valuable monitor in optimal titration of TIVA.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/13. Nasopharyngeal carcinoma with distant metastasis.We report a case of nasopharyngeal carcinoma with Chest Metastasis in a 38-year-old man. The patient presented with nasal obstruction, epistaxis, a huge neck mass and conductive hearing loss in the right ear. Examination under anaesthesia revealed a mass in the nasopharynx, which was confirmed on histology to be squamous carcinoma. He responded remarkably well to external radiotherapy with disappearance of primary tumor and neck metastasis. One year later he presented with thoraco-lumbar spine pain and cough. The nasopharynx and neck remained free of tumor while radiographs demonstrated multiple metastasis to the lungs and vertebrae.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
3/13. Tracheal lymphoepithelioma-like carcinoma: a case report.Lymphoepithelioma like carcinoma is rare in locations other than nasopharynx. We report the second case of this tumour in trachea, in a young female patient, who was managed with concomitent surgery, radiotherapy and chemotherapy. The patient is disease free in the one-year follow up. The tumour presented difficulties during intubation for general anaesthesia and during surgery. association with Epstein-Barr virus was not found in our case.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
4/13. Emergency tracheal catheterization for jet ventilation: a role for the ENT surgeon?Stridor causing respiratory failure is an ENT and anaesthetic emergency requiring prompt management to secure a clear airway. We describe a case of subacute partial upper airway obstruction due to a large laryngeal carcinoma in an 81-year-old male resulting in respiratory failure. The patient became apnoeic after gaseous induction of general anaesthesia, and after two failed intubation attempts an emergency transtracheal airway catheter was placed by the surgeon under direct vision below the cricothyroid membrane, as this had tumour involvement. The patient was subsequently manually jet-ventilated with ease until a formal tracheostomy was made. Where difficulties with tracheal anatomy are encountered due to the presence of pathology, the insertion of a temporary airway catheter for jet ventilation by the surgeon can buy valuable time and be life-saving.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
5/13. erythroplasia of Queyrat treated with topical methyl aminolevulinate photodynamic therapy.An 82-year-old man presented with invasive squamous cell carcinoma of the glans penis arising in erythroplasia of Queyrat. He underwent Mohs' micrographic surgery for the invasive carcinoma. Seven weeks later, the residual erythroplasia of Queyrat was treated using photodynamic therapy. Methyl aminolevulinate cream was applied to the glans of the penis under occlusion for 3 hours and then, after local anaesthesia, irradiated with a 630-nm red-light-emitting diode lamp at a dose of 37 J/cm(2) for 8 min. The patient experienced some mild swelling, redness and pain, which subsided over the following 5 days. Eighteen weeks after photodynamic therapy, there had been no recurrence of the lesion, when the patient died from an unrelated cause.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
6/13. Neoplasia masquerading as periapical infection.Seven examples of neoplasia which presented as periapical radiolucencies are described. These were all initially treated for presumed periapical infection. The atypical features that should alert dentists to the possibility of a tumour presenting in this manner are: a vital tooth with minimal caries, root resorption and an irregular radiolucent outline, tooth mobility in the absence of generalised periodontal disease, regional nerve anaesthesia, and failure to respond to good endodontic therapy. All material removed at the time of apical surgery must be examined histologically to prevent neoplasia being overlooked.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
7/13. Photodynamic therapy: a better treatment for widespread bowen's disease.We report here the use of photodynamic therapy to treat two patients with multiple lesions of bowen's disease. A total of over 500 lesions were treated, less than 10% requiring two treatments, and at follow-up 6 months later no lesions remained in either patient. The only important side-effect of treatment was a marked photosensitivity reaction. We consider photodynamic therapy an efficient treatment for bowen's disease; multiple lesions can be treated in a short treatment session, without local anaesthesia, and healing occurs within 2 weeks.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
8/13. Mediastinal obstruction of the trachea.Acute tracheal obstruction by a mediastinal mass is uncommon in otolaryngologic practice. Choosing techniques for securing the airway, induction of anaesthesia, and the surgical approach require careful deliberation. We report our experience in a patient with acute respiratory distress due to external compression of the trachea in the mediastinum by metastatic carcinoma. We used a fibre-optic bronchoscope ensheathed by an endotracheal tube to secure the airway. Standard tracheotomy tubes were too short to splint open the obstruction in the distal trachea, whereas the long Montgomery T-tube was effective.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
9/13. Management of superior vena cava obstruction with self-expanding intraluminal stents. Two case reports.Obstruction of the superior vena cava was relieved in two patients by intraluminal, self-expanding Gianturco stents percutaneously inserted in local anaesthesia. The cause of the obstruction was inoperable oat cell carcinoma of the bronchus in one case and irradiation for squamous cell carcinoma of the right upper lobe in the other case. Stenting gave immediate relief of symptoms in both cases, with no complications. Intraluminal stenting is a useful adjunct in the management of patients with obstruction of the superior vena cava.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
10/13. Thermoradiotherapy with combined interstitial and external hyperthermia in advanced tumours in the head and neck with depth > or = 3 cm.Advanced tumours in the head and neck 3-6 cm depth are too deep to be completely heated by external 915 MHz microwaves. A preliminary study was performed using interstitial plus external hyperthermia combined with external beam radiation therapy to heat tumours to depths > or = 3 cm. Nine advanced metastatic lesions of squamous cell carcinoma located in the head and neck were treated between 1987 and 1990 with the combined hyperthermia technique and radiation doses of 38-60 Gy (mean of 49 /- 3 Gy). The mean tumour volume was 58 /- 9 (SE) cm3 (range 24-94 cm3) with a mean tumour depth of 3.9 /- 0.3 cm (range 3-5.5 cm). The deeper aspects of the tumour were heated by interstitial 915 MHz microwave antennas and the superficial aspects heated by external 915 MHz applicators. A single plane of polyurethane closed-end catheters, 16 Ga, were inserted under local anaesthesia approximately 1.5-2 cm apart in parallel arrays at the base of a lesion behind the sternomastoid muscle, or an equivalent site in a dissected neck, extending forward and angled deeply no more than 15 degrees. Hyperthermia was administered twice weekly immediately after radiation therapy in a mean of 5.3 /- 0.7 external heat sessions (range 3-7) and a mean of 3.5 /- 0.6 interstitial heat sessions (range of 1-6). Interstitial hyperthermia was usually administered in alternating sessions with external hyperthermia, but in some patients all of the sessions of one modality were administered followed by all of the sessions of the other modality. In no case were both interstitial and external heatings performed on the same day. Surface thermometers were used to monitor skin temperature during external hyperthermia sessions. Results showed that by 8 weeks after completion of treatment, six lesions exhibited a complete response (67%) and three a partial response (33%). One of the partial responses continued to regress and became a complete response (78% complete response). The recurrence rate in complete responders was 14% (1/7) with time to recurrence of 7.7 months. Six lesions were recurrence-free at last follow-up of 21.3 /- 8.8 months. Skin reactions were absent in four fields (44%), erythema was noted in five (56%) and thermal blistering in one (11%). Ulceration occurred only in association with tumour breakdown when the skin was infiltrated by tumour (three patients, 33%).(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
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