1/145. Fatal cardiac ischaemia associated with prolonged desflurane anaesthesia and administration of exogenous catecholamines.PURPOSE: Four cardiac ischaemic events are reported during and after prolonged anaesthesia with desflurane. CLINICAL FEATURES: We have evaluated desflurane in 21 consecutive patients undergoing advanced head and neck reconstructive surgery. Four deaths occurred which were associated with cardiac ischaemic syndromes either during or immediately after operation. All patients in the study received a similar anaesthetic. This comprised induction with propofol and maintenance with alfentanil and desflurane in oxygen-enriched air. Inotropic support (either dopamine or dobutamine in low dose, 5 micrograms.kg.min-1) was provided as part of the anaesthetic technique in all patients. Critical cardiovascular incidents were observed in each of the four patients during surgery. These were either sudden bradycardia or tachycardia associated with ST-segment electrocardiographic changes. The four patients who died had a documented past history of coronary heart disease and were classified American Society of Anesthesiologists (ASA) II or III. One patient (#2) did not survive anaesthesia and surgery and the three others died on the first, second and twelfth postoperative days. Enzyme increases (CK/CK-MB) were available in three patients and confirmed myocardial ischaemia. CONCLUSION: These cases represent an unexpected increase in the immediate postoperative mortality for these types of patients and this anaesthetic sequence.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/145. Intraoperative respiratory failure in a patient after treatment with bleomycin: previous and current intraoperative exposure to 50% oxygen.patients treated with bleomycin (BLM) are at risk of developing acute respiratory distress syndrome (ARDS) post-operatively, and this has been associated with high intraoperative concentrations of oxygen. We report progressive arterial desaturation noticeable 2 h after the start of a 4-h radical neck dissection for which the anaesthesia included 50% O2 in N2O. The patient had received two courses of bleomycin within the previous 2 months and had undergone an uneventful right hemiglossectomy under shorter but otherwise similar anaesthesia 4 weeks previously. His pulmonary function tests before the second procedure showed a slight depression of diffusing capacity (DLco) to 80% of predicted and minimal airway obstruction consistent with his history of smoking. The pulse oximetric reading during his second procedure reached 75%, but rose to 95% after treatment with methylprednisolone salbutamol and inspired O2 concentrations between 80% and 100%. By the end of the procedure, he satisfied the criteria for ARDS and was transferred to the ICU, where he developed bilateral pneumonia, deteriorated and died of multiple organ failure. This case suggests that the risk of hyperoxic pulmonary damage in patients exposed to bleomycin may increase not only with the degree and duration of hyperoxia in a given exposure, but also with the latent effects of recent previous exposure. Near normality of pulmonary function tests cannot be taken as reassurance, and small changes may have more adverse prognostic significance than in patients who have not been exposed to bleomycin.- - - - - - - - - - ranking = 0.33333333333333keywords = anaesthesia (Clic here for more details about this article) |
3/145. Fatal pulmonary haemorrhage during anaesthesia for bronchial artery embolization in cystic fibrosis.Three children with cystic fibrosis (CF) had significant pulmonary haemorrhage during anaesthetic induction prior to bronchial artery embolization (BAE). Haemorrhage was associated with rapid clinical deterioration and subsequent early death. We believe that the stresses associated with intermittent positive pressure ventilation (IPPV) were the most likely precipitant to rebleeding and that the inability to clear blood through coughing was also an important factor leading to deterioration. Intermittent positive pressure ventilation should be avoided when possible in children with CF with recent significant pulmonary haemorrhage.- - - - - - - - - - ranking = 0.66666666666667keywords = anaesthesia (Clic here for more details about this article) |
4/145. Lower limb exsanguination and embolism.We report a case of fatal pulmonary embolism during lower limb exsanguination in orthopaedic surgery. A 76-year-old woman underwent an open fixation of an external femoral condyle fracture one day after injury. Subarachnoidal anaesthesia was performed and Esmarch compression bandages were applied in preparation for tourniquet ischaemia. At this time, the patient lost consciousness, became apneic and collapsed. resuscitation procedures were instituted and transoesophageal echocardiography revealed pulmonary embolism. In spite of haemodynamic support and thrombolytic therapy, the patient died. Postmortem examination revealed multiple thromboemboli of recent origin in the right heart cavities, in the pulmonary arteries and in the popliteal and tibial veins of the injured leg. Preventive, diagnostic and therapeutic options of this catastrophic event and indications of pulmonary embolectomy are discussed.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
5/145. Transient left vocal cord paralysis during laparoscopic surgery for an oesophageal hiatus hernia.A 45-year-old male, with symptoms of many years standing of gastro-oesophageal reflux disease, was subjected, under general anaesthesia, to laparoscopic fundoplication. Tracheal intubation yielded no problems but great difficulties were encountered during tube insertion into the oesophagus. After surgery, aphonia developed. Laryngological examination demonstrated paralysis of the left vocal cord. voice strength returned to the pre-operative status after 3 months, and laryngological examination confirmed normal mobility of both cords. The possible cause of the complication was damage to the left recurrent laryngeal nerve which occurred during insertion of the tube into the oesophagus. Gastro-oesophageal reflux disease causing 'acid laryngitis' can create conditions favouring this type of complication.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
6/145. Histaminoid reactions associated with rocuronium.We describe three histaminoid reactions occurring on induction of anaesthesia. The patients were all resuscitated successfully and subsequent skin testing suggested sensitivity to rocuronium. In this hospital, the incidence of such reactions is of the order of 1 in 3000. This may be coincidental but suggests that there should be close monitoring of the incidence of reactions to rocuronium. review of the cases suggests that current guidelines on management are not always followed.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
7/145. Use of magnesium sulphate as adjunctive therapy for resection of phaeochromocytoma.The intraoperative control of cardiovascular disturbances associated with the resection of phaeochromocytoma is traditionally achieved by the use of deep anaesthesia in conjunction with alpha and beta blockers, calcium antagonists, nitroglycerine or sodium nitroprusside. We report the successful use of magnesium sulphate as adjunctive therapy in the control of the cardiovascular consequences associated with surgical resection of a phaeochromocytoma in a patient.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
8/145. anaphylaxis caused by neostigmine.A patient developed anaphylaxis during anaesthesia, towards the end of surgery, 30 s after intravenous administration of neostigmine. anaphylaxis to neostigmine was confirmed by demonstrating an elevated mast cell tryptase and a strongly/positive skin prick test, showing the presence of drug-specific IgE (skin prick tests to neostigmine were negative in normal subjects). This is a rare cause of anaphylaxis during anaesthesia.- - - - - - - - - - ranking = 0.33333333333333keywords = anaesthesia (Clic here for more details about this article) |
9/145. recurrent laryngeal nerve blockade in patients undergoing carotid endarterectomy under cervical plexus block.We report two cases of recurrent laryngeal nerve blockade arising during carotid endarterectomy under cervical plexus anaesthesia. These nerve blocks were thought to be due to the instillation of local anaesthetic. The nerve block in one patient was responsible for a paroxysm of coughing which caused the formation of a large neck haematoma. We believe this to be the first report of local anaesthetic induced recurrent laryngeal nerve blockade leading to such a complication.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
10/145. awareness due to disconnection from the fresh gas supply: why could ventilation be achieved in spite of disconnection from the fresh gas supply?An anaesthesia ventilator of to-and-fro type incorporated into the anesthesia machine was used for mechanical ventilation in a patient undergoing plastic surgery under sevoflurane anaesthesia. During operation, elevation of blood pressure and tachycardia, which suggested inadequate anesthesia could not be managed by adjustment of sevoflurane to higher concentrations. However, the patient's lungs could be well ventilated without problems. Close to the end of anaesthesia, a disconnection at the mixed gas common outlet before the check valve of anaesthesia machine was detected. The patient could recall and recount all the happening during the operation signifying that he was not sufficiently anesthetized. In the case that the fresh gas supply line before the check valve is disconnected, the lungs can still be ventilated if a to-and-fro type of ventilator is used. Because there is no leakage of gas from the check valve every bit of the gas which drives the ventilator begins to work and deliver a flow of gas sufficiently to maintain a tidal volume. As a result, anaesthetic gas is replaced by a driving gas. A ventilator of to-and-fro type is still used in clinical anesthesia due to its simple design. The phenomenon reflects the pitfall in the design of a to-and-fro type anaesthesia ventilator.- - - - - - - - - - ranking = 0.83333333333333keywords = anaesthesia (Clic here for more details about this article) |
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