1/2. Obstructive sleep apnoea causing severe pulmonary hypertension reversed by emergency tonsillectomy.A three-year-old boy is reported with severe upper respiratory tract obstruction and sleep apnoea that was associated with reversible pulmonary hypertension and cardiac enlargement, and relieved by emergency tonsillectomy. The importance of intermittent cyanosis and difficulty in arousal during the day are stressed, together with the risk of death from anaesthesia in such patients without full pre-operative assessment. Despite this risk, and the current climate of increasing reluctance to subject children to tonsillectomy, the operation is absolutely essential and potentially lifesaving in certain children such as the boy described.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/2. Anaesthesia for caesarean section in a pre-eclamptic patient with Ebstein's anomaly.Anaesthetic management for Caesarean section in a pre-eclamptic patient with Ebstein's anomaly and a right to left intracardiac shunt was accomplished under general anaesthesia. air bubbles in the venous line were meticulously eliminated to prevent paradoxical air emboli. A rapid sequence induction using standard doses of thiopentone and succinylcholine did not result in loss of consciousness and muscle relaxation was inadequate for endotracheal intubation. This problem must be anticipated in patients with extremely enlarged right atria and the dose of induction agents should be increased. Carefully controlled epidural anaesthesia may be used if the cardiac reserve is adequate.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |