1/54. anaphylaxis due to suxamethonium--manifested at induction of anaesthesia by bradycardia and cardiac arrest.This case report describes an unusual presentation of a severe anaphylactic reaction following induction of anaesthesia in an elderly male patient. Full recovery followed protracted resuscitation.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/54. bradycardia and asystolic cardiac arrest during spinal anaesthesia: a report of five cases.Sudden, severe bradycardia/asystolic cardiac arrest are considered infrequent, but are certainly the most serious complications of spinal anaesthesia. We report four cases of primary asystole and one of severe bradycardia in young to middle-aged, healthy patients scheduled for minor surgery at the day surgery unit. bradycardia/asystole were not related to respiratory depression or hypoxaemia/hypercarbia; they occurred at different time intervals after the onset of spinal anaesthesia (10-70 min) and, apparently, were not dependent on the level of sensory block, which varied between T3 and T8. One patient was nauseated seconds before the asystole, otherwise there was no warning signs. All the patients were easily resuscitated with the prompt administration of atropine and ephedrine and, in the case of cardiac arrest, cardiac massage and ventilation with oxygen. One patient was treated with a small dose of adrenaline. Four patients had the surgery, as planned; one had the surgery postponed. All the patients were discharged from hospital in good health and did not suffer any sequelae.- - - - - - - - - - ranking = 1.2keywords = anaesthesia (Clic here for more details about this article) |
3/54. Microalbuminuria following anaphylaxis with general anaesthesia.Microalbuminuria is increasingly recognized as a marker of pathologies that cause acute systemic capillary leak. We report a case of an anaphylactic reaction to general anaesthesia involving cardiac arrest. In this case the urinary excretion of albumin following resuscitation suggests that severe anaphylaxis is another condition for which microalbuminuria is a sensitive monitor.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/54. Anomalous origin of the left coronary artery: discovery during an ambulatory surgical procedure in a 3-month old, previously healthy infant.We report a rare coronary anomaly in a 3-month old symptomless infant with an anomalous origin of the left coronary artery, that became manifest during anaesthesia for an ambulatory procedure, leading to circulatory arrest. Precordial stethoscope and pulse oximeter unequivocally showed a circulatory arrest. Even in ambulatory procedures, a presumed healthy patient may quickly develop a life-threatening condition because of occult disease. The successful management of such cases depends on efficient and coordinated teamwork.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
5/54. Asystole during electroconvulsive therapy: a case report.OBJECTIVE: The objective of the report is to describe a case of asystole lasting for 18 s, which developed after a subconvulsive stimulus during electroconvulsive therapy (ECT) in a patient without pre-existing cardiovascular abnormality. A brief review of the relevant literature is also provided. CLINICAL PICTURE: The patient was a 65-year-old Chinese man with a 2-year history of depression and good past medical health. Earlier he had responded well to a course of ECT without adverse effects. This time he presented with low mood, anhedonia, poor appetite and constipation. He did not respond to adequate trials with several antidepressant medications. When a subconvulsive stimulus was administered to determine the seizure threshold, no seizure activity was detected. However, immediately after the stimulus the patient developed an 18-s asystole, followed by bradycardia of 40 beats per minute for 10 s. The bradycardia resolved spontaneously before therapeutic intervention was effected. TREATMENT: Intravenous atropine was employed as premedication and suprathreshold stimulus was used in further ECT sessions. OUTCOME: Asystole did not recur in the subsequent six ECT sessions. CONCLUSION: When proper precautions are taken, asystole does not necessitate the suspension of further ECT sessions but intravenous atropine should be considered as premedication in such cases. Inducing anaesthesia with methohexital, avoiding excessive amounts of succinylcholine and employing suprathreshold stimulus and unilateral electrode placement may further lessen the likelihood of asystole in susceptible cases.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
6/54. The bispectral index during an anaphylactic circulatory arrest.A 47-year-old woman with Cushing's syndrome suffered a severe anaphylactic reaction on induction of anaesthesia, resulting in circulatory arrest. A spontaneous cardiac output appeared after 25 minutes of chest compression and she regained consciousness three hours later, with no neurological deficit. A Bispectral Index monitor demonstrated values greater than 40 throughout the whole period of resuscitation. Possible implications for this observation are discussed.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
7/54. Use of methoxamine in the resuscitation of epinephrine-resistant electromechanical dissociation.We describe three cases of electromechanical dissociation under anaesthesia that were unresponsive to doses of intravenous epinephrine given according to current Advanced life Support guidelines, but which responded immediately to the intravenous administration of the pure alpha agonist, methoxamine. We suggest a possible mechanism to explain this finding and review the literature on vasopressor drugs used for cardiopulmonary resuscitation during electromechanical dissociation. An intravenous alpha agonist, such as methoxamine 20 mg, should be considered for any case of cardiac arrest secondary to electromechanical dissociation which is unresponsive to epinephrine given according to current guidelines.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
8/54. Successful transdiaphragmatic cardiac resuscitation through midline abdominal incision in patient with flail chest.This case report describes a transdiaphragmatic approach through an already present vertical midline abdominal incision for performing internal cardiac compressions in a 30-year-old male road accident victim. The patient had a flail chest with haemopneumothorax and haemoperitoneum. Exploratory laparotomy followed by splenectomy was performed under general anaesthesia but the patient developed a witnessed cardiac arrest in postoperative period. Successful resuscitation using internal cardiac compression by a transdiaphragmatic approach through the midline abdominal incision that was not extended proximally is described.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
9/54. Cardiac arrest during ophthalmological operations.From a total number of 822 ophthalmological operations carried out under general anaesthesia two cases of cardiac arrest were observed as a result of oculocardiac reflex. The receptor for this reflex is the eye and the retrobulbal tissue, the effector is the myocardium. Children and adults with certain diseases show a predisposition to this complication. Most frequently the results of the oculocardiac reflex require no treatment, sometimes, however, resuscitation is necessary.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
10/54. Cardiac arrest associated with use of an argon beam coagulator during laparoscopic cholecystectomy.We describe a cardiac arrest during use of an argon beam coagulation (ABC) system in an 82-yr-old woman having laparoscopic cholecystectomy under general and epidural anaesthesia. Intra-abdominal pressure (IAP) was controlled to less than 12 mm Hg during a carbon dioxide gas pneumoperitoneum and at first the operation was uneventful. When the ABC system (gas flow 6 litre min(-1)) was used to control local bleeding in the liver bed abdominal pressure increased rapidly to over 20 mm Hg and, 1 min later, the end-tidal carbon dioxide decreased to zero, followed by bradycardia and cardiac arrest. At once, an emergency laparotomy was performed and resuscitation begun. A mill-wheel murmur was heard on auscultation, leading to suspicion of argon gas embolism. Fortunately, recovery was completed with no neurological deficit. Anaesthesiologists should consider showed that argon gas embolism can occur with the ABC system during laparoscopic surgery.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
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