1/7. Anaesthetic considerations in a patient with lepromatous leprosy.PURPOSE: To consider the anaesthetic problems in a patient with lepromatous leprosy undergoing general anaesthesia. CLINICAL FEATURES: A 52 yr old man with lepromatous leprosy for five years was booked for elective radical nephrectomy. He received 100 mg dapsone per day po. The patient was asymptomatic for cardiovascular disease but his electrocardiogram showed complete left bundle branch block, inferior wall ischaemia with echocardiogram findings of 58% ejection fraction and left ventricular diastolic dysfunction. Other preoperative investigations (haemogram, serum urea and creatinine, liver function tests and chest X-ray) were normal. After premedication with diazepam, meperidine and promethazine, the patient received glycopyrrolate and anaesthesia was induced with thiopentone. atracurium was given to facilitate tracheal intubation. Anaesthesia was maintained with intermittent positive pressure ventilation using N2O in oxygen with halothane. Anaesthesia and surgery were uneventful except that the patient had a fixed heart rate that remained unchanged in response to administration of anticholinergic, laryngoscopy, intubation and extubation. CONCLUSION: patients with lepromatous leprosy may have cardiovascular dysautonomia even when they are asymptomatic for cardiovascular disease.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/7. Mediastinal mass obscured by a large pericardial effusion in a child: a potential cause of serious anaesthetic morbidity.Anaesthesia in the presence of a mediastinal mass is known to be hazardous. We report a case of a 5-year-old boy with a presumed postviral pericardial effusion presenting for pericardiocentesis under general anaesthesia. Cardiorespiratory collapse following induction of anaesthesia occurred due to an undiagnosed mediastinal tumour. The reasons for misdiagnosis, mechanisms for perioperative complications and optimal management are discussed. Mediastinal masses and underlying malignancy should always be considered in patients with large pericardial effusions.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/7. Acute heart failure during spinal surgery in a boy with Duchenne muscular dystrophy.patients with Duchenne muscular dystrophy (DMD) are at high risk of perioperative complications. DMD may be accompanied by heart failure resulting from dystrophic involvement of the myocardium, which can be subclinical in the early stages of the disease. This case demonstrates that a normal preoperative ECG and echocardiograph cannot exclude the development of heart failure during anaesthesia in DMD patients undergoing major surgery.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
4/7. Cardiovascular collapse following an overdose of prostaglandin F2 alpha: a case report.A case report is presented of a parturient who suffered severe hypotension and pulmonary oedema following an overdose of intramyometrial prostaglandin F2 alpha. oxytocin induction of labour in this patient led to a rapid delivery, followed by a hypotonic uterus and postpartum haemorrhage. After resuscitation with blood and crystalloid fluids, the uterus was explored under general anaesthesia. The uterus was free of retained products but the lower uterine segment failed to contract despite bimanual uterine compression and intravenous oxytocin. Prostaglandin F2 alpha was injected into the lower uterine segment via a transvaginal approach. This was rapidly followed by cardiovascular collapse and later by pulmonary oedema. The differential diagnosis and subsequent management are discussed.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
5/7. Cardiopulmonary complications during anaesthesia and surgery for severe thoracic lordoscoliosis.A 15-year old girl underwent a posterior spinal fusion procedure for severe lordoscoliosis. On turning to the prone position acute posture-related upper airway obstruction occurred. During surgery, manipulation of the spine caused several episodes of loss of cardiac output. Retrospective assessment of the pre-operative chest X rays demonstrated approximation of the sternum and thoracic vertebrae, with evidence of tracheal narrowing at the level of the thoracic inlet. We feel that both complications were directly related to the severity of the lordoscoliosis and that careful pre-operative clinical, spirometric and X ray assessment should be undertaken in such patients.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
6/7. Peripartum cardiomyopathy presenting as a cardiac arrest at induction of anaesthesia for emergency caesarean section.Peripartum cardiomyopathy is defined as the onset of acute heart failure without demonstrable cause in the last trimester of pregnancy or within the first 6 months after delivery. It occurs in about 1 in 4000 deliveries and is often unrecognized as symptoms of normal pregnancy commonly mimic those of mild heart failure. We describe a previously asymptomatic patient who presented with a cardiac arrest at induction of general anaesthesia for emergency Caesarean section and subsequently developed acute heart failure. This case is unique both in its mode of presentation and the total absence of antecedent symptoms or signs of cardiac disease.- - - - - - - - - - ranking = 2.5keywords = anaesthesia (Clic here for more details about this article) |
7/7. 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 = 0.5keywords = anaesthesia (Clic here for more details about this article) |