1/18. Anesthetic implications of the grey platelet syndrome.PURPOSE: To describe the obstetrical anesthetic care provided to two sisters with a rare qualitative platelet disorder, the grey platelet syndrome (GPS). CLINICAL FEATURES: Both patients manifested thrombocytopenia prior to delivery without previous history of a bleeding diathesis or other abnormal laboratory tests of coagulation function. The first required emergency cesarean section due to fetal bradycardia. Due to the thrombocytopenia and the emergency nature of the procedure, general anesthesia was used. During the C-section, 1.5-2 litres of old blood was noted in the abdominal cavity which was attributed to an old splenic capsular tear of unknown etiology. work-up for the thrombocytopenia revealed large platelets on the peripheral smear with abnormal aggregation on platelet function studies. Electron microscopy of the platelets revealed absent alpha granules, diagnostic of GPS. The second patient, the sister of patient #1, presented in a similar fashion. However, at presentation, the platelet count was 112,000 x m(-3) and spinal anesthesia was provided without complication for Cesarean delivery. The same patient presented for a second delivery during which fetal bradycardia necessitated emergency C-section under general anesthesia. Despite administration of six units of platelets, blood loss was 5,200 mL. Her postpartum course was uncomplicated and she and the infant were discharged home on postoperative day #4. CONCLUSION: The primary concerns for the anesthesiologist looking after patients with qualitative platelet defects are related to defective coagulation which influences the need for perioperative replacement of blood products and limits the use of regional anesthesia.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/18. Anaphylactic reactions in anaesthetised patients - four cases of chlorhexidine allergy.chlorhexidine is widely used all over the world in many different preparations. In denmark chlorhexidine is the standard skin disinfectant used before surgery or invasive procedures and it is widely used in the general population in mouthwash or for disinfection of minor scratches etc. The potential for developing allergy to chlorhexidine is thus great, especially in surgical patients. We have identified four patients with serious allergic reactions in connection with surgery and general anaesthesia, who on subsequent skin testing tested positive for chlorhexidine. Symptoms appeared 20-40 min into the operation and all four patients required treatment with adrenaline. All four patients had a history of minor symptoms like rashes or faints in connection with previous surgery/invasive procedures. Allergy to chlorhexidine may be more prevalent in surgical patients and cases may have been overlooked due to the nature of reactions and lack of suspicion towards this substance.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/18. Lesion of the common peroneal nerve during arthroscopy.Arthroscopic knee surgery has been well accepted worldwide and has become an important part of orthopaedic surgery. The use of arthroscopy has reduced the duration of hospitalization, overall costs, and time required for the patient to return to sports activities or work. However, because of the closed nature of the procedure and proximity of neurovascular structures to instruments, substantial risk of injuries exists. Significant anatomic variability in the nerve course has not been reported in previous literature as a cause of a knee arthroscopy complication. We present a case of complete transection of an unusually located common peroneal nerve during a knee arthroscopy for lateral meniscal repair in a 22-year-old football player.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/18. Strabismic complications following endoscopic sinus surgery: diagnosis and surgical management.INTRODUCTION: Endoscopic surgical techniques improve the surgeon's view of sinus structures but are subject to extraocular muscle complications that cause permanent diplopia. methods: A series of 15 patients with strabismus following endoscopic sinus surgery was reviewed retrospectively to characterize the type of muscle injury and report the results of surgical correction. RESULTS: A variety of insults to the medial rectus (MR) muscle occurred, ranging from contusion, hematoma, oculomotor nerve damage with paralysis, muscle transection, and muscle destruction. Inferior rectus and superior oblique muscle trauma was observed. High-resolution computed tomography and magnetic resonance imaging scans proved essential in determining the extent and nature of muscle injury. Surgical approaches included anterior orbitotomy with muscle recovery and transposition procedures. CONCLUSIONS: Several extraocular muscles may be traumatized. Timing and type of surgical treatment depend on severity, type of injury, and number of muscles involved. If the remaining posterior segment of the MR muscle is longer than 20 mm and is contractile, muscle recovery via anterior orbital approach is suggested. If injury is more severe, muscle transposition procedures may be helpful. In cases where there is coexistent medial and inferior rectus injury, transposition procedures may not be possible. Inactivation of the antagonist and use of an orbital periosteal flap as a globe tether to center it may be options.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/18. Inadvertent intraforaminal iliosacral screw placement despite apparent appropriate positioning on intraoperative fluoroscopy.We present the case of an intraforaminal iliosacral screw placed percutaneously with aid of C-arm using inlet, outlet, and lateral views of the pelvis. The iliosacral screw was placed above the S1 foramen on the outlet view, into the middle of S1 via the ala on the inlet view, and below the cortical shadow of the ala on the lateral view. The patient was neurologically intact postoperatively, but began to complain of severe radicular pain in the S1 distribution down to the foot within 1 week postsurgery. There was mild weakness of plantar flexion. Postoperative computed tomography scan showed that the iliosacral screw was within the S1 foramen. Because of the tangential nature of the S1 foramen, slight posterior placement of the screw into the S1 body and not into the promontory resulted in violation of the foramen despite it being above the cortical shadow on the outlet view.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/18. McArdle's disease and anaesthesia: case reports. review of potential problems and association with malignant hyperthermia.BACKGROUND: McArdle's disease of isolated deficiency in glycogen degradation in skeletal muscles has the potential of creating perioperative anaesthesiological problems; such as hypoglycaemia, rhabdomyolysis, myoglobinuria, acute renal failure and possibly malignant hyperthermia. methods: Eight patients with McArdle's disease were asked about previous surgery, anaesthesia and perioperative problems, and available hospital records were reviewed. Existing literature was reviewed for reports on McArdle's disease and anaesthesia. RESULTS: The eight patients had 35 anaesthesias (23 general anaesthesias, three regional anaesthesias and nine local anaesthesias). Perioperative problems of a non-specific nature were mentioned in three cases of general anaesthesia: two with postoperative nausea/vomiting, and one with an episode of tachycardia and low blood pressure. Three patients were tested for malignant hyperthermia (MH) using the in vitro contracture test (IVCT); two of them with a positive result. The literature search revealed seven case reports of McArdle's disease and anaesthesia. Apart from one report of hyperthermia, pulmonary oedema and rhabdomyolysis; probably not associated with MH, no problems were encountered from the literature search. CONCLUSION: McArdle's disease does not seem to cause severe perioperative problems in routine anaesthetic care. However, measures for preventing muscle ischaemia and rhabdomyolysis should be kept in mind, as well as the potential for these patients to develop postoperative fatigue, myoglobinuria and renal failure. Although no clinical association with malignant hyperthermia has been established, many of these patients can have a positive in vitro contracture test, and simple prophylactic measures, as with malignant hyperthermia, may be recommended if otherwise not contraindicated.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/18. cauda equina syndrome secondary to an improperly placed nucleotome probe.Automated percutaneous lumbar discectomy has been shown to be a low morbidity procedure in the treatment of contained herniated lumbar discs. Described in this paper is a complication, i.e., a cauda equina syndrome secondary to a Nucleotome probe improperly placed in the thecal sac. The authors reemphasize the landmarks for the thecal sac, i.e., the medial border of the pedicles, and discuss the preventable nature of this type of complication.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/18. Major vascular complications of orthognathic surgery: hemorrhage associated with Le Fort I osteotomies.Major intraoperative or postoperative bleeding associated with Le Fort I osteotomies can be venous and/or arterial in nature. Arterial hemorrhage generally involves the maxillary artery and its terminal branches. Arterial hemorrhage tends to be more persistent and can be recurrent, which makes it more difficult to manage. Postoperative bleeding following Le Fort I osteotomies generally presents as epistaxis and usually occurs initially within the first 2 weeks following surgery. Treatment modalities that have been used to successfully arrest postoperative hemorrhage include anterior and/or posterior nasal packing; packing of the maxillary antrum; reoperating with clipping or electrocoagulation of bleeding vessels, or the use of topical hemostatic agents in the pterygomaxillary region; external carotid artery ligation; and selective embolization of the maxillary artery and its terminal branches.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/18. Recurrent intraoperative choroidal effusion in sturge-weber syndrome.The formation of a massive choroidal effusion without hemorrhage during a trabeculectomy procedure was documented in a 17-year-old male with sturge-weber syndrome, most probably representing the youngest patient in the literature with this intraoperative complication. The occurrence of similar signs during a previous trabeculectomy procedure in the same eye, suggested the possible recurrent nature of this entity. Preparation of a posterior sclerotomy site before entering the eye during intraocular surgery in patients with Sturge-Weber Syndrome might help in the immediate management and in preventing complications due to the formation of massive choroidal effusion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/18. Surgical presentations of ehlers-danlos syndrome type IV. A case report.The case of a 28 year old man with ehlers-danlos syndrome (EDS) type IV is presented. He had the typical facies of this disorder, thin skin with atrophic scars and bruised easily. He suffered with congenital clubbed feet, heavy blood loss and poor wound healing following a traumatic compound fracture of the right leg, recurrent spontaneous pneumothoraces for which a pleurectomy was performed, two episodes of vascular rupture following minor trauma, one managed conservatively and the other surgically, and one episode of massive spontaneous vascular rupture which was fatal. In this report we highlight the surgical nature of the presenting complications of EDS type IV and demonstrate the hazards of surgical management. We conclude that, when possible, conservative management is preferable.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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