1/2. Diaphragmatic rupture after epidural anaesthesia in a patient with diaphragmatic eventration.An 85-year-old man with undiagnosed eventration of the left hemidiaphragm had an above-knee amputation under epidural anaesthesia. His post-operative course was stormy with two episodes of cardiovascular collapse. On the third post-operative day, rupture of the left hemidiaphragm was diagnosed, the bowel had herniated into the left hemithorax. It is proposed that the left hemidiaphragm ruptured spontaneously because of muscular weakness secondary to the thoracic segmental blockade associated with lumber epidural anaesthesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/2. Anaesthesia for repair of neonatal diaphragmatic hernia and eventration: role of ketamine infusion.Management of neonates with congenital diaphragmatic defects who have symptoms within hours of birth is still unsatisfactory. The mortality reported for these high-risk infants ranges from 20% to 80%. Anaesthesia for repair of these defects is nonetheless the most perilous phase in these conditions. Surgery often worsens the situation with regard to blood gases. The anaesthesia has to fulfil the criteria for neonatal surgery and thoracic surgery with the added components of elevated pulmonary vascular resistance and pulmonary hypoplasia. The mortality figures are worse if there is lack of a proper neonatal intensive care facility. The management of two such cases is discussed with special stress upon use of the ketamine infusion technique as an alternative safe anaesthetic regime.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |