1/10. Contrast echocardiography and transcranial Doppler sonography for detection of a patent foramen ovale.We report the case of a patient, in whom a patent foramen ovale was detected. For the detection of a patent foramen ovale simulation of Valsalva's manoeuvre with a positive airway pressure of 20 cm H2O was applied. Change of ventilation manoeuvre by ventilation with positive airway pressure of 35/30/15 cm H2O at a tidal volume of 1200 ml make a distinct increase in passage of contrast medium from the right to the left atrium. These findings were detected by contrast transesophageal echocardiography and indirectly by transcranial Doppler sonography and were reproducible. This may stress the importance of preoperative screening of patent foramen ovale in patients to be operated on in the sitting position. Contrast echocardiography and the ventilatory manoeuvre with high airway pressure and PEEP might increase the detection rate of patent foramen ovale with a right to left shunt during general anaesthesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/10. Transcatheter closure of atrial septal defects using the Cardio-Seal implant.OBJECTIVE: To review the outcomes of transcatheter closure of atrial septal defects using the Cardio-Seal implant. DESIGN: A prospective interventional study. SETTING: Tertiary referral centre. patients: The first 50 patients (median age 9.7 years) who underwent attempted percutaneous occlusion. INTERVENTIONS: Procedures were done under general anaesthesia and transoesophageal guidance between December 1996 and July 1998. MAIN OUTCOME MEASURES: Success of deployment, complications, and assessment of right ventricular end diastolic diameter, septal wall motion, and occlusion status by echocardiography. RESULTS: The median balloon stretched diameter was 14 mm. Multiple atrial septal defects were present in 11 patients (22%) and a deficient atrial rim (< 4 mm) in 19 (38%). In four patients (8%), a second device was implanted after removal of an initially malpositioned first implant. There were no significant immediate complications. All patients except one were discharged within 24 hours. At the latest follow up (mean 9.9 months) a small shunt was present in 23 patients (46%), although right ventricular end diastolic dimensions (mean (SD)) corrected for age decreased from 137 (29)% to 105 (17)% of normal, and septal motion abnormalities normalised in all but one patient. No predictors for a residual shunt were identified. Supporting arm fractures were detected in seven patients (14%) and protrusion of one arm through the defect in 16 (32%), the latter being more common in those with smaller anterosuperior rims. No untoward effects resulted from arm fractures or protrusion. There were no complications during follow up, although five patients (10%) experienced transient headaches. CONCLUSIONS: The implantation of the Cardio-Seal device corrects the haemodynamic disturbances secondary to the right ventricular volume overload, with good early outcome.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/10. Anaesthetic considerations for a child with combined prader-willi syndrome and mitochondrial myopathy.We report the anaesthetic management of a child with prader-willi syndrome and mitochondrial myopathy for open heart surgery. We used ketamine, fentanyl, rocuronium and caudal morphine together with a propofol infusion with no untoward effects. The implications of both conditions for anaesthesia are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/10. Intracardiac echocardiography and transcranial Doppler ultrasound to guide closure of patent foramen ovale.Intracardiac echocardiography is the newest imaging technology permitting whole-heart evaluation from a right-sided catheter position and contrast transcranial Doppler is an ideal method to noninvasively quantify right-to-left cardiac shunt in real time, by the detection of bubble passage across the brain arteries. The combination of these two methods enables us to take advantage of online therapeutic information for successful deployment of the Amplatzer PFO Occluder in a 63-year-old man with severe chronic obstructive pulmonary disease, avoiding the need for transesophageal echocardiography and general anaesthesia or sedation.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/10. A fine balance--one-lung ventilation in a patient with Eisenmenger syndrome.A 38-yr-old woman with an atrial septum defect and Eisenmenger syndrome was scheduled for a lung biopsy via thoracoscopy during one-lung ventilation. Fluids were given to increase central venous pressure to 8 mm Hg, an epidural catheter was inserted at the sixth thoracic intervertebral space and ropivacaine 0.3%, 6 ml were given. Careful balance of systemic and pulmonary vascular resistance is crucial in Eisenmenger syndrome, so norepinephrine (0.14 mg kg(-1) min(-1)) was infused before general anaesthesia was started with fentanyl 4 mg kg(-1), ketamine 2 mg kg(-1), pancuronium 1 mg and succinylcholine 2 mg kg(-1). Anaesthesia was maintained with propofol 4-8 mg kg(-1) h(-1). To control pulmonary artery pressure, ventilation was performed with oxygen 100% and nitric oxide 20 ppm. Surgery and anaesthesia course were uneventful and the patient was extubated. However, pleural haemorrhage required treatment with blood components, re-intubation on the second postoperative day and removal of the haematoma by mini-thoracotomy. A step-by-step approach using a balanced combination of regional and general anaesthesia, controlled fluid administration, norepinephrine and inhaled nitric oxide preserved a stable circulation even during one-lung ventilation. The diagnostic value of lung biopsy must be weighed against the possibility of life-threatening haemorrhage.- - - - - - - - - - ranking = 3keywords = anaesthesia (Clic here for more details about this article) |
6/10. Methaemoglobinaemia after cardiac catheterisation: a rare cause of cyanosis.Two young women had unexpected cyanosis a few hours after cardiac catheterisation for electrophysiological investigation. The first patient had atrioventricular septal defect, had undergone repeated surgical interventions, and was referred because of atrial flutter. The second patient had ablation of an accessory pathway in wolff-parkinson-white syndrome. Local anaesthesia was performed with 40 ml prilocaine 2%. cyanosis with oxygen saturation of 85% developed in both patients a few hours after the electrophysiological investigation. The patients were transferred to the intensive care unit and for the first patient a considerable diagnostic effort was made to rule out morphological complication. Finally methaemoglobinaemia of 16.7% and 33.4%, respectively, was found. cyanosis resolved within 24 hours and did not reappear. Underlying glucose-6-phosphate dehydrogenase deficiency and erythrocyte-methaemoglobin reductase deficiency were ruled out. physicians should be aware of this rare side effect of local anaesthetics in patients with unexpected cyanosis.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
7/10. Failure to awaken after general anaesthesia secondary to paradoxical venous embolus.A patient is presented who failed to regain consciousness after an apparently uneventful nine-hour revision of a total hip replacement. There were no clinically important haemodynamic changes during the operation, and oxygen saturation, capnography and acid base balance were normal throughout. Postop CT of the head showed a large left MCA infarct with midline shift. At autopsy, the patient was found to have a previously unsuspected patent foramen ovale, and a venous embolus in the left internal carotid artery, which probably had originated from the periprostatic venous plexus with a large infarct in the distribution of the left anterior and middle cerebral arteries. The authors conclude that massive paradoxical venous emboli can occur during surgery with minimal haemodynamic changes.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
8/10. Cardiac anaesthesia in a patient with myotonic dystrophy.We describe a patient with myotonic dystrophy who required open-heart surgery for an atrial septal defect. He also had a sick sinus syndrome and an abnormal myocardium on histological examination. Anaesthesia using fentanyl, droperidol, nitrous oxide and a low concentration of enflurane was uneventful. Atelectasis of the left lung developed on the first postoperative day after removal of the tracheal tube. This was successfully treated by fibreoptic bronchoscopy.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
9/10. Anaesthetic considerations in a patient with fraser syndrome.A 16-year-old girl with fraser syndrome underwent abdominal hysterectomy under general anaesthesia. She had multiple congenital anomalies which included a cardiac defect and airway abnormalities. intubation difficulties were circumvented by the retrograde technique of placement of the tracheal tube.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
10/10. 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 = 1keywords = anaesthesia (Clic here for more details about this article) |
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