1/10. Persistent anaphylactic reaction after induction with thiopentone and cisatracurium.A 6-year-old boy presented for surgery for phimosis. The anaesthetic technique included intravenous induction with thiopentone and neuromuscular blockade with cisatracurium. Severe persistent bronchospasm and central cyanosis followed the administration of these drugs. A continuous i.v. infusion of epinephrine at 0.2 microg. kg(-1) x min(-1) was necessary to break the severe refractory bronchial hyperresponsiveness. There was no previous exposure to anaesthetic drugs and no definite family history of allergy. Through increased serum eosinophil cationic protein, tryptase and histamine levels and IgE levels specific to cisatracurium, we demonstrated an IgE-mediated anaphylactic reaction to cisatracurium in the child's first exposure to this new neuromuscular blocking agent. Anaphylactic reactions to new anaesthetic drugs may be challenging to recognize and treat during general anaesthesia in children. The pathogenesis, diagnosis and management of life threatening persistent allergic reactions to intravenous anaesthetics are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/10. Swelling and cyanosis of the tongue associated with use of a laryngeal mask airway.We present a case report of a patient who developed acute swelling of the tongue during anaesthesia using the laryngeal mask airway. The swelling was thought to be due to obstruction of the venous drainage of the tongue. This was associated with isolated cyanosis of the tongue and paraesthesia. The swelling and cyanosis of the tongue resolved rapidly after removal of the laryngeal mask airway. The patient suffered paraesthesia of the tip of the tongue that lasted for two weeks.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/10. Methaemoglobinaemia after cardiac catheterisation: a rare cause of cyanosis.Two young women had unexpected cyanosis a few hours after cardiac catheterisation for electrophysiological investigation. The first patient had atrioventricular septal defect, had undergone repeated surgical interventions, and was referred because of atrial flutter. The second patient had ablation of an accessory pathway in wolff-parkinson-white syndrome. Local anaesthesia was performed with 40 ml prilocaine 2%. cyanosis with oxygen saturation of 85% developed in both patients a few hours after the electrophysiological investigation. The patients were transferred to the intensive care unit and for the first patient a considerable diagnostic effort was made to rule out morphological complication. Finally methaemoglobinaemia of 16.7% and 33.4%, respectively, was found. cyanosis resolved within 24 hours and did not reappear. Underlying glucose-6-phosphate dehydrogenase deficiency and erythrocyte-methaemoglobin reductase deficiency were ruled out. physicians should be aware of this rare side effect of local anaesthetics in patients with unexpected cyanosis.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/10. An unexpected cause of an acute hypersensitivity reaction during recovery from anaesthesia.Acute hypersensitivity reactions to chlorhexidine in the operating room are probably more likely to occur during the early phases of anaesthesia because chlorhexidine is often used for cleaning the surgical field or during placement of indwelling catheters. We report a case of an acute hypersensitivity reaction that occurred in the post anaesthetic care unit. Subsequent skin testing suggested sensitivity to chlorhexidine, which had been applied over the vaginal mucosa at the end of surgery. Relevant issues in the investigation of acute hypersensitivity reactions in the post anaesthetic period are discussed.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
5/10. Anaesthetic management of Osler-Weber-Rendu syndrome with coexisting congenital methaemoglobinaemia.A 9-year-old cyanosed child suffering from Osler-Weber-Rendu syndrome with bilateral pulmonary arteriovenous malformations (PAVMs) was posted for cerebral angiography under general anaesthesia. Careful preanaesthetic evaluation led to the diagnosis of coexisting congenital methaemoglobinaemia. There is no previous report of Osler-Weber-Rendu syndrome coexisting with congenital methaemoglobinaemia. This report emphasizes that a second contributory cause of cyanosis must be suspected and meticulously looked for if the symptomatology in a patient cannot be explained by a single established diagnosis. Positive-pressure ventilation was associated with reduction in arterial oxygenation despite an increasing inspired oxygen concentration, which returned to preanaesthetic levels only after extubation and resumption of spontaneous respiration.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
6/10. Fatal pulmonary oedema following laparoscopic chromopertubation.The body of a 30-year-old woman was received for autopsy. The available medical case records mentioned that she had been married for the past 3 years and had had primary infertility. She had undergone a diagnostic-cum-operative laparoscopy under general anaesthesia in a private nursing home. On laparoscopy, the internal genital organs were normal except for a fimbrial cyst on each side. Chromopertubation was done using methylene blue dye along with diagnostic dilatation and curettage. The patient was extubated and shifted to the recovery room. About 15 minutes later she developed cyanosis and became unconscious. She died despite sustained efforts at resuscitation.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
7/10. cyanosis of the hands following the use of alphaprodine in dental anaesthesia.A case is presented of asymptomatic cyanosis of the hands, seen four hours after dental surgery under intravenous, local and inhalational anaesthesia. alphaprodine hydrochloride, a synthetic opiate and one of the agents used, may produce dilatation of the venous bed with passive venous pooling. Such a mechanism is thought to have occurred in this case, manifesting as cyanosis. A weakly positive intradermal skin test to alphaprodine suggests immediate type hypersensitivity as a possible underlying cause.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
8/10. Scleroderma. Complications encountered during dental anaesthesia.A young woman with scleroderma required a dental extraction for which general anaesthesia was considered appropriate. A cyanosed and painful hand followed the intravenous injection of methohexitone, and an oral laceration occurred during the extraction of a molar tooth.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
9/10. A polygraphic study of one case of primary alveolar hypoventilation (Ondine's curse).We report here on a case of primary alveolar hypoventilation in a 9 yr old child. From the age of 8 years, the patient has suffered from episodes of bronchopneumonia associated with severe respiratory insufficiency and lethargy. After recovery, cyanosis developed during the night and, later on, during the day. On two occasions, serious respiratory depression followed ketamine sedation for cardiac catheterization and total anaesthesia for cerebral angiography. Pulmonary function tests showed normal volumes and normal mechanics of breathing; blood gas analysis revealed a slight hypercapnic acidosis and hypoxia. The ventilatory response to CO2 was virtually absent, whereas voluntary hyperventilation normalized blood gas values. A polygraphic recording during sleep showed a marked worsening of hypoventilation, which occurred soon after falling asleep and continued throughout all sleep stages; sporadic central apnoeas, at times prolonged, were recorded only during light sleep. The patient, now 14 yr old, is maintained in satisfactory condition with low flow nocturnal oxygen administration combined with the use of a body respirator during sleep twice a week.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
10/10. Congenital methaemoglobinaemia detected by preoperative pulse oximetry.Methaemoglobinaemia is an unusual cause of cyanosis whether it is congenital or acquired. Hence, the diagnosis may not be immediately obvious and appropriate treatment may be delayed. The case described shows that it should be considered when pulse oximetry and arterial blood gas analysis appear to give conflicting results. A healthy 24-yr-old woman was found to have a pulse oximeter reading of 82% prior to induction of anaesthesia for minor surgery. Clinical examination confirmed cyanosis but no other abnormality was detected. She had no important medical history and was not receiving any medications. Arterial blood gas analysis with the patient breathing air showed PaO2 12.03 kPa (90 mmHg). Co-oximeter analysis of this sample revealed a methaemoglobin content of 13.4% and she was subsequently found to have congenital methaemoglobin reductase deficiency. Anaesthesia was induced and maintained with incremental doses of propofol and fentanyl. A spontaneously breathing technique with oxygen in nitrous oxide was employed uneventfully. No specific treatment for methaemoglobinaemia was given. Perioperative pulse oximetry is one of the major advances in patient monitoring in recent years but unexpected results should not be accepted uncritically. A knowledge of the working principles of oximetry is essential to enable appropriate management in the presence of dyshaemoglobins.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
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