1/121. Intraoperative loss of auditory function relieved by microvascular decompression of the cochlear nerve.BACKGROUND: Brainstem auditory evoked potentials (BAEP) are useful indicators of auditory function during posterior fossa surgery. Several potential mechanisms of injury may affect the cochlear nerve, and complete loss of BAEP is often associated with postoperative hearing loss. We report two cases of intraoperative auditory loss related to vascular compression upon the cochlear nerve. methods: Intra-operative BAEP were monitored in a consecutive series of over 300 microvascular decompressions (MVD) performed in a recent twelve-month period. In two patients undergoing treatment for trigeminal neuralgia, BAEP waveforms suddenly disappeared completely during closure of the dura. RESULTS: The cerebello-pontine angle was immediately re-explored and there was no evidence of hemorrhage or cerebellar swelling. The cochlear nerve and brainstem were inspected, and prominent vascular compression was identified in both patients. A cochlear nerve MVD resulted in immediate restoration of BAEP, and both patients recovered without hearing loss. CONCLUSION: These cases illustrate that vascular compression upon the cochlear nerve may disrupt function, and is reversible with MVD. awareness of this event and recognition of BAEP changes alert the neurosurgeon to a potential reversible cause of hearing loss during posterior fossa surgery.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
2/121. dna polymorphism analysis in transfusion-associated graft-versus-host disease.During cardiac surgery for transposition of the great arteries at age 7 weeks, a female infant received blood, fresh frozen plasma and platelet transfusions. Eleven days postoperatively, she developed bloody diarrhoea, fever, an erythematous macular rash, hepatomegaly, seizures and pancytopaenia. A clinical diagnosis of transfusion related graft-versus-host disease (GVHD) was supported by skin histopathology. dna polymorphism studies confirmed that circulating lymphocytes in peripheral blood and infiltrating cells in the skin were foreign in origin and were derived from transfused blood cells. No underlying immunodeficiency was identified. Treatment with steroids cyclosporin and antithymocyte globulin was unsuccessful and death occurred 2 months after surgery. The features of fever, rash, diarrhoea, liver dysfunction and pancytopaenia which characterize GVHD may mimic drug reactions or viral infection. In addition to histological features on skin biopsy. dna polymorphism studies on skin and blood samples provide a unique and sensitive method to confirm GVHD. Irradiation of blood products should be considered for acutely compromised infants requiring urgent cardiac surgery.- - - - - - - - - - ranking = 0.25159489228772keywords = drug (Clic here for more details about this article) |
3/121. Possible theophylline toxicity during anesthesia.Asthmatic patients who undergo outpatient anesthesia are typically prescribed one or more drugs for treatment. Some of these agents have narrow therapeutic ranges and are associated with potentially serious adverse reactions, toxic effects, or drug interactions. Various clinical signs of toxicity may be first uncovered during routine monitoring of an office anesthetic. The case reported here demonstrates the need for proper understanding of the asthmatic patient's medical history and an appreciation for the medications used to control the disease. A sudden cardiovascular event possibly related to drug toxicity is witnessed and treated in an asthmatic patient during intravenous sedation. A possible drug interaction with a non-asthmatic medication taken concomitantly by the patient is implicated and discussed. In addition to the case report, the broad classification of drugs employed for bronchial asthma and their effects is reviewed.- - - - - - - - - - ranking = 1.2579744614386keywords = drug (Clic here for more details about this article) |
4/121. Catheter entrapment by atrial suture during minimally invasive port-access cardiac surgery.PURPOSE: The port-access approach allows surgeons to perform heart operations through small intercostal openings, or "ports". This technique requires new skills for anesthesiologists. A pulmonary artery venting (PAV) catheter and, in some cases, a coronary sinus catheter (for administration of retrograde cardioplegia) are positioned with the aid of fluoroscopy and transesophageal echography (TEE). Both catheters have a wider diameter than the more commonly used conventional PA catheter and present distinctive features. We report a case in which a pulmonary artery venting catheter was entrapped by a suture during a port-access procedure. CLINICAL FEATURES: A 35-yr-old man with severe mitral valve insufficiency was scheduled for valve repair. After a successful bypass procedure, resistance was felt while attempting to withdraw the PAV catheter. On fluoroscopy, fixation of the catheter at the heart level was established and perforation by suture was confirmed after injection of a contrast agent. Because of the risk of cardiac wall rupture and tamponade, the thorax was reopened. After release of some atrial sutures, the catheter could be withdrawn easily. Transfixion by a suture was confirmed by visual examination. CONCLUSION: The more frequent use of a PAV catheter in minimally invasive cardiac surgery with the port-access technique should remind the anesthesiologist of the higher risk of entrapment by surgical sutures. Surgeons should be aware of the risk of accidentally transfixing this catheter during closure of the atriotomy via the port.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
5/121. Surgical management of arteriosclerotic coronary artery aneurysm.A 60-year-old man suffered antero-septal myocardial infarction at the age of 56. coronary angiography demonstrated total occlusion of the left anterior descending artery and a large saccular aneurysm of the right coronary artery. Diffuse coronary ectasia was also shown in the right coronary artery adjacent to the aneurysm. Despite anticoagulant therapy, the aneurysm formed a thrombus and developed coronary artery stenosis distal to the aneurysm. ligation of the aneurysm and in situ gastroepiploic artery grafting were performed. Sudden heart failure was developed during skin closure. As this condition was considered to be graft hypoperfusion, supplemental saphenous vein grafting was placed. ligation is a simple, reliable technique to prevent future complications for a large saccular right coronary artery aneurysm, however, gastroepiploic artery might be an inappropriate bypass conduit for the ligated coronary artery with diffuse ectasia.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
6/121. cerebrospinal fluid leakage during endscopic forehead lifting.PURPOSE: To report a case of endoscopic brow lift in which cerebrospinal fluid leakage was encountered. METHOD: A 69-year-old otherwise healthy man underwent endoscopic forehead lifting. RESULTS: An area of strong adherence was encountered in the area of the left superior paracentral scalp incision. As the adherence was released, clear fluid extruded (cerebrospinal fluid) and a burr hole was discovered. Absorbable gelatin sponge was placed over the dural defect and burr hole, and closure of the endoscopic scalp incisions was accomplished. CONCLUSION: Caution is suggested in performing this procedure when a patient has any history of a head trauma.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
7/121. Posterior hepatic duct injury during laparoscopic cholecystectomy finally necessitating hepatic resection: case report.A case of bile duct injury during laparoscopic cholecystectomy finally necessitating right hepatic lobectomy is reported to re-emphasize the importance of preoperative and intraoperative assessment of the biliary tree. A 47-year-old Japanese woman underwent laparoscopic cholecystectomy for cholecystolithiasis. On postoperative day 5, fever and right hypochondralgia developed, and CT revealed fluid collection at the right hypochondrium. Percutaneous drainage was performed, and subsequent fistulography revealed a communication of the cystic cavity with the right posterior bile duct, which suggested injury of the aberrant hepatic duct. Conservative therapy, including the adaptation of fibrin glue, was performed, but closure of the fistula and cavity was not obtainable. Finally, a right hepatic lobectomy was performed four months after cholecystectomy. In this case, endoscopic retrograde cholangiopancreatography was unsuccessful preoperatively, and intraoperative cholangiography was not done. This case report re-emphasizes that the preoperative and intraoperative examination of the biliary tree is mandatory to avoid bile duct injury.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
8/121. Successful treatment of massive arterial air embolism during open heart surgery.We report a case of a 5-year-old girl who suffered a massive arterial air embolism during surgical closure of an atrial septal defect. The risk of permanent neurologic deficits or even fatal outcome is significant (mortality rate, 31%). We successfully treated a proven arterial air embolism with intraoperative (retrograde cerebral perfusion) combined with postoperative procedures (deep barbiturate anesthesia and hyperbaric oxygenation). At discharge the girl had fully recovered from the initial neurologic defects.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
9/121. Orthotopic liver transplantation for carcinoid tumour metastatic to the liver: anesthetic management.PURPOSE: To report the anesthetic management of a patient with carcinoid tumour metastatic to the liver who presented for orthotopic liver transplantation. Anesthetic implications of metastatic carcinoid tumour on liver transplantation and the use of octreotide are discussed. CLINICAL FEATURES: A 51-yr-old woman with intestinal carcinoid tumour metastatic to the liver presented for orthotopic liver transplantation, a recent treatment option for patients with extensive hepatic carcinoid metastases and disabling symptoms unresponsive to conventional therapy. Despite continuous administration of the somatostatin analogue octreotide via a hepatic artery infusate pump, the patient suffered from daily break through symptoms, which included flushing, palpitations, paroxysmal hypertension, and dyspnea. The patient presented to the operating room with sinus tachycardia and severe arterial hypertension. octreotide and phentolamine were used to prevent further mediator release and to control the paroxysmal hypertension. midazolam, fentanyl, thiopental, succinylcholine, vecuronium, and isoflurane were used to induce and maintain anesthesia safely. An intravenous octreotide infusion was initiated after induction and continued throughout the case. Infrequent and non-threatening peaks in arterial blood pressure were readily treated with small intravenous doses of vasoactive drugs and octreotide. No other manifestations of the carcinoid syndrome occurred. The patient had an uneventful recovery and was discharged on postoperative day #6. CONCLUSION: The patient safely underwent orthotopic liver transplantation for treatment of symptomatic carcinoid tumour metastatic to the liver. The anesthetic management followed recent recommendations favouring the use of octreotide to prevent patients from becoming symptomatic. Outlined dosing regimen for octreotide provided satisfactory hemodynamic stability.- - - - - - - - - - ranking = 0.25159489228772keywords = drug (Clic here for more details about this article) |
10/121. Surgical treatment for severe diabetic macular edema with massive hard exudates.PURPOSE: Massive diabetic macular exudates respond poorly to conventional laser treatment. The purpose of this study was to analyze the surgical results of eyes with massive hard exudates secondary to diabetic macular edema treated with combined pars plana vitrectomy, posterior hyaloid removal, focal endolaser treatment, and panretinal photocoagulation. methods: The author retrospectively analyzed the surgical outcome of 13 consecutive eyes (11 patients) with massive diabetic macular exudates. All patients had had at least one session of focal and/or grid laser treatment without any effect. Pars plana vitrectomy, posterior hyaloid removal, focal macular endolaser treatment, and intraoperative panretinal photocoagulation were performed. Postoperative visual acuity, evolution of macular edema, and hard exudates were recorded. RESULTS: All 13 eyes showed significant decreases in macular edema and hard exudates, a process that became clinically obvious 3 months after the operation. Eleven eyes had improved vision of at least two lines during an average follow-up period of 14.8 months. Intraoperative and postoperative complications included angle closure glaucoma (one eye), persistent vitreous hemorrhage (two eyes), choroidal detachment (one eye), intravitreal fibrin formation (one eye), epiretinal membrane formation (one eye), and neovascular glaucoma (one eye). CONCLUSION: Combined surgery may offer an opportunity for improvement of vision and reduction of massive macular exudates in patients with severe diabetic macular edema.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
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