1/3. Acute respiratory insufficiency after endoscopy for bleeding oesophageal varices.Two patients with alcoholic liver disease and gross ascites underwent endoscopic injection and compression by Sengstaken tube of oesophageal varices under general anaesthesia. Postoperatively both patients developed acute respiratory failure, which resolved after air had been aspirated from the stomach via the Sengstaken tube. All air should be aspirated at the end of the procedure in patients with ascites who undergo endoscopy, and respiration should be carefully supervised postoperatively.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Anaesthesia for the patient with neonatal adrenoleukodystrophy.The authors present and discuss the care of a nine-month-old with neonatal adrenoleukodystrophy who required general anaesthesia for gastrointestinal endoscopy. Neonatal adrenoleukodystrophy is an inherited disorder of peroxisomal enzymes. Anaesthetic care may be affected by the presence of hypotonia, liver function abnormalities, gastroesophageal reflux, and impaired adrenocortical function. Preoperative sedation is contraindicated because of the risk of precipitating airway obstruction due to pre-existing hypotonia. Anaesthetic induction and tracheal intubation should be performed to minimize the risk for aspiration of gastric contents. The choice of muscle relaxant should take into account the pre-existing hypotonia as well as the possibility of hyperkalaemia in response to succinylcholine. Anaesthetic agents known to decrease the seizure threshold should be avoided in patients with a seizure disorder. In addition, anaesthetic agents that rely on the liver for metabolism should be used with caution in patients with cirrhosis. When time permits, these patients should be screened for adrenocortical insufficiency before surgery, and perioperative steroid coverage is advisable when preoperative testing of adrenocortical function is not feasible. While these patients eventually die after progressive deterioration, full recovery from the effects of anaesthesia and surgery can be achieved with attention to neurological, metabolic, and physical problems.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
3/3. diagnosis and anaesthesia management of haemophilia during the neonatal period.We report here the case of a newborn infant admitted to our hospital for moderate gastro-intestinal bleeding. Despite abnormal value for aPTT, diagnosis of moderate haemophilia A was only made preoperatively when surgery was deemed necessary to treat pyloric stenosis. Clinical circumstances of the diagnosis and anaesthesia management of haemophilia during the neonatal period are discussed.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |