1/10. Epileptiform activity in the EEGs of two nonepileptic children under sevoflurane anaesthesia.Two case reports of nonepileptic children are presented, who developed paroxysmal EEG potentials in routinely performed EEG recordings during inhalation of sevoflurane, 7 and 8% by volume respectively. Taking into account several reports from the literature about epileptiform potentials or convulsive movements under similar conditions, it seems to be important to investigate carefully the circumstances under which these phenomena appear as well as possible clinical consequences.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/10. Oral midazolam for adults with learning disabilities.This paper demonstrates how oral midazolam can be employed as an alternative method of behaviour management to general anaesthesia for the dental treatment of people with learning disabilities. A range of treatments, from scaling to root canal therapy, can be carried out successfully using the sedation technique outlined. The advantages of sedation include reduced morbidity and mortality. Treatment outcomes are also likely to be improved as root canal therapy and periodontal care can be carried out over a number of visits rather than a single treatment session under general anaesthesia. Oral sedation with midazolam should improve the scope of dental treatment available to patients with disabilities.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
3/10. Anaesthesia for bilateral mastectomy in a Jehovah's Witness patient with epilepsy and review of alternatives to homologous blood transfusion.The anaesthetic management of a Jehovah's Witness patient for bilateral mastectomy for carcinoma of the breast is described. The patient is also a known epileptic patient who developed fits the night before surgery. Surgery was re-scheduled for one week later to allow control of the epilepsy. Surgery was carried out under general anaesthesia. The patient refused blood transfusion. Modified normovolaemic haemodilution was the alternative to homologous blood transfusion used in the patient. This was safe except for the post-operative morbidity due to severe anaemia in the patient. The surgical outcome was good. The safety of not transfusing blood in Jehovah's Witness patient for surgical procedures for which blood transfusion is needed is well illustrated by this case. A review of alternatives to homologous blood transfusion is done.- - - - - - - - - - ranking = 0.25keywords = anaesthesia (Clic here for more details about this article) |
4/10. Postoperative pseudoepileptic seizures in a known epileptic: complications in recovery.A 47-yr-old woman underwent general anaesthesia for a squint correction. She had previously suffered a cerebral venous thrombosis, presenting as grand mal seizures during recovery from general anaesthesia for minor surgery. Subsequently, she was affected by Jacksonian limb seizures and petit mal epilepsy and had required long-term rehabilitation, and anticonvulsant and anticoagulant therapy. On arrival in recovery on this occasion, with a laryngeal mask airway (LMA) in place, she started to convulse. The seizures were initially treated with midazolam i.v., but they recurred. Whilst observing the seizure pattern and excluding the differential diagnoses, evidence emerged that psychological factors had played a large part in her clinical picture. Her differential diagnosis had recently been amended to include 'pseudoseizures'. A firm, supportive approach caused the 'convulsions' to cease within a few hours.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
5/10. Anaesthetic dilemma: spinal anaesthesia in an eclamptic patient with mild thrombocytopenia and an "impossible" airway.We present our anaesthetic management of a 27-year-old woman with antepartum eclampsia, mild thrombocytopenia, difficult airway and clinical evidence of impending upper airway obstruction. She required urgent delivery by caesarean section, which was conducted uneventfully under spinal anaesthesia. We discuss the management conundrums presented by this case and why we chose spinal anaesthesia over other anaesthetic options.- - - - - - - - - - ranking = 1.5keywords = anaesthesia (Clic here for more details about this article) |
6/10. Anaesthetic-induced ventricular tachyarrhythmia in Jervell and Lange-Nielsen syndrome.A four-year-old deaf girl with a history of convulsions developed polymorphous ventricular tachycardia during induction of anaesthesia. The arrhythmia reverted to sinus rhythm spontaneously. Post-anaesthetic ECG showed marked prolongation of the QTc interval (570-690 msec). deafness and prolonged QTc interval in association with microcytic-hypochromic anaemia confirmed the diagnosis of the Jervell and Lange-Nielsen syndrome. This case report highlights the potentially lethal complication of halothane anaesthesia in patients with long QTc interval syndrome.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
7/10. Delivery complicated by myasthenia gravis and epilepsy.The literature on the possible risk of myasthenia gravis complicating pregnancy and delivery is sparse and partly contradictory but some of the reports on the number of perinatal and neonatal deaths are alarming. epilepsy in pregnancy implies on approximately twofold risk of intervention in connection with labour. A pregnant patient with myasthenia gravis and epilepsy has recently been delivered. The case is reported and the considerations with regard to suitable anaesthesia and the two diseases are discussed.- - - - - - - - - - ranking = 0.25keywords = anaesthesia (Clic here for more details about this article) |
8/10. Epileptic EEG discharges during burst suppression.Barbiturate anaesthesia is used in the treatment of status epilepticus and severe epilepsy of children. EEG is then used as a measure of the depth of anaesthesia, burst suppression being an easily identified EEG pattern. In this case report we describe epileptiform discharges during EEG suppression in two children undergoing barbiturate anaesthesia for treatment of intractable seizures. One of them had focal, rhythmic discharges of negative spikes on the positive suppression level. Bursts were readily produced by visual stimuli with flashes of red light but this did not increase the frequency of focal spike discharges after bursts. The other patient had generalised, high amplitude spike-wave complexes, which were easy to distinguish from the bursts. We emphasise that it is important to make a distinction between electrocerebral silence, or isoelectric EEG as it was previously called, from EEG suppression. It is also important to distinguish epileptiform discharges from bursts, if the intention is to keep the anaesthesia at EEG burst suppression level.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
9/10. Anaesthesia for dental conservation in a patient with tuberous sclerosis.General anaesthesia for a patient with tuberous sclerosis was complicated by epilepsy. The choice of drugs was related to control of his fits and intercurrent therapy. Thiopentone, vecuronium, and nitrous oxide with isoflurane were satisfactory.- - - - - - - - - - ranking = 0.25keywords = anaesthesia (Clic here for more details about this article) |
10/10. Intracranial haemodynamics during attenuated responses to electroconvulsive therapy in the presence of an intracerebral aneurysm.OBJECTIVES: This report describes successful anaesthesia and electroconvulsive therapy (ECT) in a patient with an unruptured basilar artery aneurysm. ECT is associated with a hyperdynamic state characterised by arterial hypertension, tachycardia, and considerably increased cerebral blood flow rate and velocity. These responses pose an increased risk for subarachnoid haemorrhage when an intracranial aneurysm coexists. methods: A 54 year old woman presented for ECT. She had a 20 year history of major depression which was unresponsive to three different antidepressant drugs. There was also an unruptured 5 mm saccular aneurysm at the basilar tip, which had been documented by cerebral angiography, but its size had remained unchanged for the previous four years. After she declined surgical intervention, she gave informed consent for ECT. During a series of seven ECT sessions middle cerebral artery flow velocity was recorded by a pulsed transcranial Doppler ultrasonography system. She was pretreated with 50 mg oral atenolol daily, continuing up to the day of the last ECT and immediately before each treatment, sodium nitroprusside was infused at a rate of 30 microg/min, to reduce systolic arterial pressure to 90-95 mm Hg. RESULTS: Systolic flow velocity during the awake state ranged from 62-75 cm/s, remaining initially unchanged with sodium nitroprusside infusion. After induction of anaesthesia (0.5 mg/kg methohexitone and 0.9 mg/kg succinylcholine), flow velocities decreased to 39-54 cm/s, reaching maximal values of 90 cm/s (only 20% above baseline) after ECT. These flow velocities recorded post-ECT were considerably below the more than twofold increase recorded when no attenuating drugs were used. Systolic arterial blood pressure reached maximal values of 110-140 mm Hg and heart rate did not exceed 66 bpm. Rapid awakening followed each treatment, no focal or global neurological signs were apparent, and the patient was discharged in remission. CONCLUSION: In a patient with major depression and a coexisting intracerebral saccular aneurysm who was treated with ECT, the combination of beta blockade with atenolol and intravenous infusion of sodium nitroprusside prevented tachycardia and hypertension, and greatly attenuated the expected increase in flow velocity in the middle cerebral artery.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
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