1/8. Tumour lysis syndrome during anaesthesia.We describe a child who developed acidosis, hyperkalaemia and cyanosis while emerging from an otherwise uneventful anaesthetic. A diagnosis of tumour lysis syndrome was suspected and confirmed biochemically. Although this syndrome is usually associated with chemotherapy and has been described to occur spontaneously, it has not previously been reported as being associated with anaesthesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/8. Emergency anaesthesia in a patient with Gordon's syndrome.Gordon's syndrome is a rare condition characterized by hypertension and hyperkalemia despite normal renal glomerular function. We report the administration of an anaesthetic to one such patient for an urgent surgical procedure. The patient's serum potassium was only marginally raised at the outset of the procedure. During surgery the serum potassium rose significantly, but responded to conventional management. Hyperkalaemia is a specific electrolyte disturbance that has numerous implications for the administration of an anaesthetic. Most importantly, there is a danger that further acute elevations may occur, caused by the surgery, the anaesthetic, or the condition itself- - - - - - - - - - ranking = 0.8keywords = anaesthesia (Clic here for more details about this article) |
3/8. Hyperkalaemic periodic paralysis and anaesthesia.Hyperkalaemic periodic paralysis is the rarer of the two forms of potassium-associated familial paralysis. We report a family with hyperkalaemic periodic paralysis with paramyotonia and the anaesthetic management of four affected members. In three of these, paralytic episodes had been precipitated by previous anaesthesia, but this was avoided in the anaesthetics described. We conclude from our experiences that with depletion of potassium before surgery, prevention of carbohydrate depletion, avoidance of potassium-releasing anaesthetic drugs and maintenance of normothermia, patients with hyperkalaemic periodic paralysis can be anaesthetised without complications. We have no evidence that they exhibit abnormal sensitivity to nondepolarising neuromuscular relaxants.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/8. Atypical malignant hyperthermia with persistent hyperkalaemia during renal transplantation.A 35-year-old 110 kg male developed marked hyperkalaemia, hyponatraemia, hypercapnia and hyperthermia during living-related renal transplantation under anaesthesia with oxygen-nitrous oxide, isoflurane and muscle relaxation with atracurium. This is the first report of successfully treated malignant hyperthermia triggered by isoflurane during renal transplantation with early appearance and persistent (to 12 hours after surgery) electrolyte abnormalities.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
5/8. Duchenne muscular dystrophy and malignant hyperthermia--two case reports.The case histories are presented including the anaesthetic and postoperative management, of two children, a two-year-old with undiagnosed Duchenne muscular dystrophy (DMD) and a three-year-old with known DMD. The child with undiagnosed DMD had no symptoms of DMD and had received halothane twice before, without succinylcholine, with no apparent difficulty. Following an uneventful induction of anaesthesia with halothane, nitrous oxide and O2, succinylcholine resulted in bilateral masseter muscle spasm and then, in rapid sequence, ventricular tachycardia and cardiac arrest. resuscitation was difficult, prolonged and associated with hyperkalaemia (K = 12.57 mEq X L-1), severe metabolic and respiratory acidosis, high peripheral venous pressure and massive hepatosplenomegaly, but not hyperthermia. The patient was finally resuscitated but died two days later. Skeletal muscle biopsy results were consistent with malignant hyperthermia. The second patient was known to have DMD but did not receive prophylactic or intraoperative dantrolene nor have his anaesthetic machine flushed with oxygen for an extended period prior to induction of anaesthesia. This child was anaesthetized with fentanyl and N2O and, with the exception of a high intraoperative heart rate (155-160 beats X min-1), had an uncomplicated anaesthetic and operation (intraoperative axillary temperatures ranged between 36.8-37.9 degrees C). Postoperatively his temperature rapidly increased to 38.8 degrees C and then 40.3 degrees C and he became metabolically acidotic. Intravenous administration of dantrolene for 48 hours reduced the temperature and allowed normal recovery and discharge. A postoperative muscle biopsy was consistent with DMD.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.4keywords = anaesthesia (Clic here for more details about this article) |
6/8. succinylcholine-induced cardiac arrest in children with undiagnosed myopathy.Two paediatric cases are reported in which unexpected, life-threatening arrhythmias occurred. Routine induction of general anaesthesia with thiopentone, 5 mg.kg-1, in one and with halothane in the other, and succinylcholine 1.25-1.5 mg.kg-1 i.v. was followed by the development of wide complex tachyarrhythmia with hypotension in the first case and asystole in the second case despite pre-treatment with atropine in both cases. The first patient was resuscitated with tracheal intubation, 100% oxygen, manual ventilation and intravenous lidocaine and bicarbonate. The second patient required intubation, manual ventilation, 12 min of CPR and i.v. calcium, epinephrine and bicarbonate, as well as DC counter shock. Neither patient received dantrolene. Early recovery in both patients was uneventful with no neurological sequelae. Subsequent investigations revealed the presence of a dystrophin-deficient muscular dystrophy, duchenne muscular dystrophy and Becker muscular dystrophy respectively, previously unsuspected, in both patients. The aetiology of the observed arrhythmias was presumably hyperkalaemia, secondary to succinylcholine-induced rhabdomyolysis. It is suggested that when faced with sudden, life-threatening arrhythmias following succinylcholine at induction of anaesthesia for paediatric patients, clinicians should include occult myopathy in the differential diagnosis, and thus consider the aggressive management of hyperkalaemia in addition to basic resuscitative efforts.- - - - - - - - - - ranking = 0.4keywords = anaesthesia (Clic here for more details about this article) |
7/8. Suxamethonium-induced hyperkalaemia in patients with severe intra-abdominal infections.In nine patients, undergoing repeat operations because of severe intra-abdominal infection developing after major abdominal surgery, serum potassium concentrations were monitored during induction of anaesthesia. Four patients showed an increase of serum potassium ranging from 2.5 to 3.1 mmol/litre above baseline values within 3-6 min after suxamethonium 100 mg i.v. In five patients there was no change. The four patients demonstrating an increase had suffered from pyrexia and leucocytosis for at least 2 weeks. The other five had signs of infection for no more than 9 days. It is concluded that patients with signs of severe intra-abdominal infection lasting longer than 1 week represent an additional category susceptible to suxamethonium-induced hyperkalaemia. They should receive only non-depolarizing muscle relaxants. When the use of suxamethonium is unavoidable, the injection of a non-depolarizing muscle relaxant before the administration of suxamethonium is recommended.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
8/8. Intraoperative QRS-interval changes caused by hyperkalaemia in an infant with Arima syndrome.A one-year-and-ten-months-old male infant with Arima syndrome, a very rare genetic disorder, underwent urgent insertion of a catheter for continuous ambulatory peritoneal dialysis (CAPD) under general anaesthesia. During the procedure he showed QRS-interval changes caused by hyperkalaemia which was successfully treated with calcium gluconate. The management and intraoperative complications of this syndrome are reported and available literature reviewed.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |