1/3. Anaesthetic management of congenital heart block and persistent ductus arteriosus in an infant.ketamine hydrochloride, pancuronium bromide and 100% oxygen were used during general anaesthesia for a left antero-lateral thoracotomy, insertion of a permanent cardiac pace-maker and ligation of a persistent ductus arteriosus in a three-month-old female infant, who was also in congestive cardiac failure. To the best of our knowledge, this is the first reported case of successful anaesthetic management for insertion of cardiac pace-maker and ligation of persistent ductus arteriosus under general anaesthesia in a Nigerian infant. The successful out-come of our anaesthetic technique encourages us to recommend the procedure for the anaesthetic management of similar complex cardiac abnormalities.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Pulmonary hypertension and pregnancy: a series of eight cases.This is the report of a series of eight patients with pulmonary hypertension (primary and secondary) who delivered at the McMaster University Medical Centre between 1978 and 1987. Seven of the eight patients delivered vaginally and had a successful outcome. The eighth patient was admitted as an emergency and died shortly after Caesarean section under general anaesthesia, performed to save the infant. The other seven patients were all managed by a team, including anaesthetists, cardiologists and obstetricians, from about 25 wk. The patients were hospitalized pre-partum and received oxygen therapy and anticoagulation with heparin. analgesia in labour was managed, once anticoagulation was reversed, by low concentrations of epidural bupivacaine (0.125%-0.375%) and fentanyl. The patients were monitored during labour and delivery with oximetry and arterial and central venous pressure lines. Pulmonary arterial lines were not used because of increased risk and questionable usefulness. Vaginal delivery was managed with vacuum extraction or forceps lift-out to minimize the stress of pushing. After delivery, all patients were monitored in an intensive care unit for several days, anticoagulation was restarted, and all patients were discharged home taking oral anticoagulant therapy. The successful management of pulmonary hypertension in pregnancy should include team management started early in pregnancy and controlled vaginal delivery utilizing epidural analgesia.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
3/3. Simultaneous delivery of two patent arterial duct coils via one venous sheath.A female child, 10 months of age, weighing 7.2 kg, was catheterised for closure of a patent arterial duct. aortography was performed in the lateral projection and the minimum diameter of the arterial duct was assessed by comparing it to the size of the catheter. The duct size was estimated between 3 and 3.5 mm at the narrowest point, therefore, it was decided to deliver two 5 mm patent arterial duct coils to avoid placement of an 8 mm coil in this small child. Similar operations were subsequently performed in two further children. Simultaneous delivery of two coils via a single long venous sheath is easy, fast, and safe. This simple and inexpensive procedure can reduce irradiation and anaesthesia time.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |