1/93. An uncommon mechanism of brachial plexus injury. A case report.PURPOSE: To report a case of brachial plexus injury occurring on the contralateral side in a patient undergoing surgery for acoustic neuroma through translabrynthine approach. CLINICAL FEATURES: A 51-yr-old woman underwent surgery for acoustic neuroma through translabrynthine approach in the left retroauricular area. She had a short neck with a BMI of 32. Under anesthesia, she was placed in supine position with Sugita pins for head fixation. The head was turned 45 degrees to the right side and the neck was slightly flexed for access to the left retroauricular area, with both arms tucked by the side of the body. Postoperatively, she developed weakness in the right upper extremity comparable with palsy of the upper trunk of the brachial plexus. hematoma at the right internal jugular vein cannulation site was ruled out by CAT scan and MRI. The only remarkable finding was considerable swelling of the right sternocleidomastoid and scalene muscle group, with some retropharyngeal edema. An EMG confirmed neuropraxia of the upper trunk of brachial plexus. She made a complete recovery of sensory and motor power in the affected limb over the next three months with conservative treatment and physiotherapy. CONCLUSIONS: brachial plexus injury is still seen during anesthesia despite the awareness about its etiology. Malpositioning of the neck during prolonged surgery could lead to compression of scalene muscles and venous drainage impedance. The resultant swelling in the structures surrounding the brachial plexus may result in a severe compression.- - - - - - - - - - ranking = 1keywords = plexus (Clic here for more details about this article) |
2/93. The management of non-traumatic cardiac arrest in the operating room with cardiopulmonary bypass.We present a case of a 29-year-old woman whom, while undergoing an elective gynecological procedure, acutely arrested. Closed chest cardiopulmonary compressions were not effective. Fortuitously, the cardiac surgical team was in an adjacent operating room, about to start an elective bypass case. After sternotomy, the patient was placed on cardiopulmonary bypass within 20 min of the arrest. The patient achieved return of spontaneous circulation and was ultimately discharged with only mild extremity weakness. The etiology of the arrest was never fully explained. Open chest massage and cardiopulmonary bypass should be considered early in the management of unexpected cardiac arrest, especially in the operating room where surgical expertise should be immediately available. Surgeons and anesthesiologists need to be aware of, and consider, the possibility of employing these techniques.- - - - - - - - - - ranking = 0.021754854515485keywords = chest (Clic here for more details about this article) |
3/93. Laparoscopic repair of pleural laceration produced during truncal vagotomy: case report.A partial pneumothorax developed in a patient undergoing laparoscopic truncal vagotomy when a small pleural laceration was accidentally produced. Changes in oxygen saturation and PETCO2 were immediately detected by the anesthesiologist and measures were taken to maintain the patient's ventilatory stability. The pleural laceration was repaired laparoscopically, and the pneumothorax was corrected by ventilatory manipulation, avoiding the placement of a chest tube. The procedure was completed uneventfully. literature about the causes of pneumothorax during laparoscopic procedures as well as preventive and therapy viewed.- - - - - - - - - - ranking = 0.010877427257742keywords = chest (Clic here for more details about this article) |
4/93. Capsular block syndrome and pseudoexpulsive hemorrhage.Capsular block syndrome (CBS) has been recognized as a cause of immediate or delayed postoperative accumulation of fluid behind an intraocular lens/capsulorhexis complex. Hydrodissection-related rupture of the posterior capsule may be considered a variant of CBS that can manifest intraoperatively. We describe another intraoperative situation related to CBS in which fluid loculation during hydrodissection mimics a threatened expulsive hemorrhage.- - - - - - - - - - ranking = 0.090511941388645keywords = behind (Clic here for more details about this article) |
5/93. 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 = 0.55555555555556keywords = plexus (Clic here for more details about this article) |
6/93. Unintentional transfixation of a transverse cervical vein during placement of an interscalene brachial plexus catheter.Cervical hematoma during placement of a catheter into the interscalene groove is a known complication of the procedure. I describe the occurrence of a hematoma while using a new system that is compatible with a nerve stimulator and offers the ability to aspirate during both needle placement and catheter insertion.- - - - - - - - - - ranking = 0.44444444444444keywords = plexus (Clic here for more details about this article) |
7/93. Bilateral pneumothorax with extensive subcutaneous emphysema manifested during third molar surgery. A case report.This report describes a case of bilateral pneumothorax with extensive subcutaneous emphysema in a 45-year-old man that occurred during surgery to extract the left lower third molar, performed with the use of an air turbine dental handpiece. Computed tomographic scanning showed severe subcutaneous emphysema extending bilaterally from the cervicofacial region and the deep anatomic spaces (including the pterygomandibular, parapharyngeal, retropharyngeal, and deep temporal spaces) to the anterior wall of the chest. Furthermore, bilateral pneumothorax and pneumomediastinum were present. In our patient, air dissection was probably caused by pressurized air being forced through the operating site into the surrounding connective tissue.- - - - - - - - - - ranking = 0.010877427257742keywords = chest (Clic here for more details about this article) |
8/93. Bilateral tension pneumothorax during jet ventilation: a case report.Jet ventilation (JV) involves high-pressure ventilation for upper laryngeal laser procedures. Anesthetic management for the patient undergoing JV can be challenging, as complications of JV can include subcutaneous emphysema and tension pneumothorax. A 52-year-old woman with a diagnosis of vocal cord polyps presented for direct microlaryngoscopy and laser laryngoplasty with JV. Intraoperatively, the patient developed lack of bilateral chest movement and an audible change in jet-ventilatory sounds. The patient was reintubated with a standard endotracheal tube. Subsequent attempts to ventilate the patient failed. A diagnosis of bilateral tension pneumothorax was made. Immediate pleural decompression resulted in improved ventilatory and hemodynamic status. The purpose of this case report is to discuss the pathophysiology related to tension pneumothorax and anesthetic implications for management of cases involving JV.- - - - - - - - - - ranking = 0.010877427257742keywords = chest (Clic here for more details about this article) |
9/93. Tension pneumothorax as a complication of video-assisted thorascopic surgery for anterior correction of idiopathic scoliosis in an adolescent female.STUDY DESIGN: This case report illustrates the occurrence of intraoperative tension pneumothorax, a previously unreported complication occurring during anterior instrumentation for correction of scoliosis by video-assisted surgery. OBJECTIVES: To demonstrate a consequence of overadvancement of a Steinmann pin (guide wire). SUMMARY OF BACKGROUND DATA: Although intraoperative tension pneumothorax is admitted to be a theoretical complication of video-assisted surgery for anterior correction of idiopathic scoliosis, there has yet to be a case reported in the literature. This report presents the first case of this complication. methods: A 13-year-old girl who had right thoracic scoliosis with a curve measuring 54 degrees underwent video-assisted surgery discectomy and anterior spinal fusion with instrumentation of T5 through T11. Single-lung ventilation had been achieved with a double-lumen tube and the right lung was deflated. After approximately 4.5 hours of complication-free surgery, intraoperative fluoroscopy showed an approximately 2-cm overadvancement of a guide wire into the opposite hemithorax. Approximately 5 minutes after the overadvancement was corrected, the patient experienced a gradual increase in heart rate and a corresponding gradual decrease in oxygen saturation and both systolic and diastolic blood pressures. Approximately 35 minutes later, it was determined that the patient had sustained a tension pneumothorax of the left hemithorax. RESULTS: The patient underwent urgent partial reinflation of the right lung and a tube thoracostomy of the left thoracic cavity. vital signs quickly returned to stable levels, and the left lung easily reinflated with the chest tube suction. The patient remained stable after the procedure was resumed (by right lung deflation). The remainder of the surgery and the postoperative course were uneventful. CONCLUSIONS: Although video-assisted surgery continues to gain popularity in the management of spinal deformities, the surgical team must be certain to pay meticulous attention to detail throughout the procedure. The early detection and treatment of complications can be life-preserving.- - - - - - - - - - ranking = 0.010877427257742keywords = chest (Clic here for more details about this article) |
10/93. Successful resuscitation after catastrophic carbon dioxide embolism during laparoscopic cholecystectomy.A 92-year-old female was scheduled for laparoscopic cholecystectomy. Following intraperitoneal carbon dioxide insufflation and removal of her gallbladder, the patient developed serious haemodynamic deterioration associated with a decrease of both end-tidal carbon dioxide concentration (ETCO2) and chest compliance. carbon dioxide embolism was suspected and the diagnosis was confirmed by aspiration of 20 mL of foamy blood from the central venous line. The patient was successfully resuscitated after discontinuation of carbon dioxide insufflation and ventilation of the lungs with 100% oxygen. carbon dioxide embolization must always be suspected during laparoscopic surgery whenever sudden haemodynamic deterioration associated with a decrease in ETCO2 and chest compliance occur.- - - - - - - - - - ranking = 0.021754854515485keywords = chest (Clic here for more details about this article) |
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