1/6. Fatal cardiac ischaemia associated with prolonged desflurane anaesthesia and administration of exogenous catecholamines.PURPOSE: Four cardiac ischaemic events are reported during and after prolonged anaesthesia with desflurane. CLINICAL FEATURES: We have evaluated desflurane in 21 consecutive patients undergoing advanced head and neck reconstructive surgery. Four deaths occurred which were associated with cardiac ischaemic syndromes either during or immediately after operation. All patients in the study received a similar anaesthetic. This comprised induction with propofol and maintenance with alfentanil and desflurane in oxygen-enriched air. Inotropic support (either dopamine or dobutamine in low dose, 5 micrograms.kg.min-1) was provided as part of the anaesthetic technique in all patients. Critical cardiovascular incidents were observed in each of the four patients during surgery. These were either sudden bradycardia or tachycardia associated with ST-segment electrocardiographic changes. The four patients who died had a documented past history of coronary heart disease and were classified American Society of Anesthesiologists (ASA) II or III. One patient (#2) did not survive anaesthesia and surgery and the three others died on the first, second and twelfth postoperative days. Enzyme increases (CK/CK-MB) were available in three patients and confirmed myocardial ischaemia. CONCLUSION: These cases represent an unexpected increase in the immediate postoperative mortality for these types of patients and this anaesthetic sequence.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/6. Anaesthetic considerations in a parturient with critical coronary artery disease and a drug-eluting stent presenting for caesarean section.A parturient presented with her first symptoms of coronary artery disease at 18 weeks' gestation. Following an angiogram, a drug-eluting stent was inserted, resulting in resolution of her symptoms. The patient was prescribed anti-platelet medication including clopidogrel. She was delivered by elective caesarean section at 35 weeks under general anaesthesia. The anaesthetic management is discussed and a review of the literature presented.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
3/6. Precipitous bradycardia induced by laryngoscopy in cardiac surgical patients.We present three patients with severe ischaemic heart disease who developed profound bradycardia (heart rates of 15 beats.min-1, 10 beats.min-1 and asystole) at the time of laryngoscopy and spraying of the trachea with topical lidocaine. All patients had received fentanyl 20-30 micrograms.kg-1 and pancuronium 0.1-0.13 mg.kg-1 and in each case laryngoscopy was performed three minutes after the administration of these agents. We believe that in these cases the dosage of fentanyl was inadequate and since increasing the dosage of fentanyl to at least 50 micrograms.kg-1 and eliminating the manoeuvre of laryngeal spraying with topical anaesthesia, we have not encountered this problem.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
4/6. Anaesthetic management of a patient with carcinoid tumor undergoing myocardial revascularization.Carcinoid tumors with hepatic involvement can produce intense flushing, tachycardia, hypotension or hypertension and diarrhoea. patients with limited cardiac reserve may not tolerate these effects under anaesthesia. Valvular heart disease associated with carcinoid tumors has been reported, but there is no record in the literature of such an association with coronary artery disease. This report presents the anaesthetic management of a patient with coronary artery disease and carcinoid tumor undergoing myocardial revascularization. Emphasis is placed on the rational use of anaesthetic and adjunctive agents which will minimize the incidence of carcinoid symptons. The salient features of the management are prevention of release of vasoactive substances by the use of promethazine hydrochloride during operation, the avoidance of stropine, prophylactic administration of corticosteroids and smooth induction of anaesthesia by the use of diazepam and dimethyl-tubocurarine iodide (Metocurine).- - - - - - - - - - ranking = 0.33333333333333keywords = anaesthesia (Clic here for more details about this article) |
5/6. Anaesthetic management for caesarean section in a patient with Kawasaki disease.Kawasaki disease (KD) or mucocutaneous lymph node syndrome is an acute febrile illness affecting mainly children under four years of age. The most important clinical feature of this disease is coronary arteritis associated with aneurysms and thrombotic occlusions, which may lead to ischaemic heart disease or sudden death. It has now been more than 20 yr since its first description, and a number of survivors of childhood KD have reached child-bearing age. Despite the possible fatal outcome of this disease in adult patients with coronary artery manifestations, no information is available regarding the obstetrical anaesthetic management of patients with a history of KD. The purpose of this report is to describe the successful use of epidural anaesthesia in a patient with a history of KD undergoing Caesarean section and to discuss the anaesthetic considerations that should be given to adult survivors of childhood KD.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
6/6. Torsade de pointes ventricular tachycardia following coronary artery spasm during general anaesthesia.We present a patient who suffered two episodes of torsade de pointes ventricular tachycardia during general anaesthesia for abdominal surgery. The first occurred on suctioning of the tracheobronchial tree and the second while anaesthesia was light. Since ST segment elevation was in each case noted before the onset of torsade de pointes, coronary artery spasm was suspected to be the cause. An intravenous infusion of nitroglycerine was effective in treating and preventing these episodes. These findings suggest that coronary artery dilators such as nitroglycerine are indicated for initial treatment of torsade de pointes following coronary artery spasm in order to facilitate recovery from myocardial ischaemia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |