1/7. Severe hyperphosphataemia and associated electrolyte and metabolic derangement following the administration of sodium phosphate for bowel preparation.sodium phosphate is widely used as an effective bowel preparation agent. It is used in smaller volumes, leading to improved patient tolerance. Although it is generally safe, cases of severe hyperphosphataemia following sodium phosphate administration have been reported in the literature. The common risk factors identified are advanced age, impaired renal function, impaired colonic motility and multiple doses. However, many doctors remain unaware of the dangers associated with this agent. We report six cases of severe electrolyte and metabolic derangement due to sodium phosphate bowel preparation: two patients had delayed awakening from general anaesthesia, and four patients suffered life-threatening consequences.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/7. Brainstem anaesthesia after retrobulbar block: a rare cause of coma presenting to the emergency department.Local anaesthesia, in particular retrobulbar block, is commonly used to perform cataract surgery. Known complications of retrobulbar block include cranial nerve palsies, seizures and cardiorespiratory arrest. We report a case of brainstem anaesthesia causing apnoea and loss of consciousness in a man who received retrobulbar block. The likely mechanism is inadvertent dural puncture of the optic nerve sheath and local anaesthetic injection into the cerebrospinal fluid space. As in this case, the literature reports a short-lived period of anaesthesia with usually no long-term sequelae. Although rare, it is a life-threatening complication if the patient is not appropriately resuscitated. This case highlights the need for trained personnel, with suitable monitoring and adequate resuscitation facilities in order to perform this technique.- - - - - - - - - - ranking = 7keywords = anaesthesia (Clic here for more details about this article) |
3/7. Delayed excitatory reaction following interaction of cocaine and monoamine oxidase inhibitor (phenelzine).A case report is presented in which a patient receiving the monoamine oxidase inhibitor, phenelzine, developed a delayed excitatory reaction following administration of topical cocaine spray during anaesthesia for vocal cord surgery. The pharmacological basis of the drug interaction is discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/7. Delayed recovery from general anaesthesia.A case of postoperative coma associated with diabetes insipidus and hypothermia is presented. Some recommendations are offered for the future management of similar cases.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
5/7. Galanthamine hydrobromide, a longer acting anticholinesterase drug, in the treatment of the central effects of scopolamine (Hyoscine).Galanthamine hydrobromide, an anticholinesterase drug capable of penetrating the blood-brain barrier, was used in a patient demonstrating central effects of scopolamine (hyoscine) overdosage. It is longer acting than physostigmine and is used in anaesthesia to reverse the non-depolarizing neuromuscular block. However, studies into the dose necessary to combating scopolamine intoxication are indicated.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
6/7. Clinical risk management. Building provider awareness in the administration of anaesthesia.The area of anaesthesia has long been the focus of risk management concerns. This article will address a case study based on some of the high risk issues. Although the environment in which anaesthesia is administered is usually a carefully controlled area, the anaesthetic agents and the patient's response to them can be unpredictable. Injuries sustained as a result of anaesthetic administration and anaesthesia can be serious with life-long and costly disabilities and even death. tables 1 and 2 highlight the risk management areas to address in anaesthesia and tables 3 and 4 the risk issues which have occurred from over 20 years experience in the USA. (MMI Companies Inc. 1993). Many of these issues will be discussed in the case study scenario. Further reading around the risk issues will also be suggested.- - - - - - - - - - ranking = 8keywords = anaesthesia (Clic here for more details about this article) |
7/7. Horner's syndrome resulting from a prolonged abnormal posture during a coma.BACKGROUND: Horner's syndrome results from the impairment of the sympathetic nerve supply to the eye and orbit. Other nerve palsies from prolonged unchanged posture are well described, but Horner's syndrome following prolonged lateral flexion has only twice been seen previously and these cases were in association with anaesthesia. methods/RESULTS: A case is described of Horner's syndrome resulting from a prolonged period of unchanged posture from an alcohol-induced coma. A review of the anatomy of Horner's syndrome is presented. CONCLUSION: To my knowledge, this is the first reported case of Horner's syndrome resulting from a coma.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |