1/6. Total intravenous anaesthesia and the use of an intubating laryngeal mask in a patient with osteogenesis imperfecta.osteogenesis imperfecta is a genetically determined rare disease of the connective tissue, associated with abnormalities of type 1 collagen. The primary bone lesion is the lack of normal ossification of the endochondrial bone. patients with osteogenesis imperfecta present several problems for anaesthetists. They have a tendency to develop malignant or non-malignant hyperthermia. During laryngoscopy and tracheal intubation, the mandible, teeth and cervical spine may be fractured or injured, and mucosal bruising or bleeding may occur. Renal or ureteral stones are common. The main problems are thus with airway control and intubation, and the risk of anaesthetic agents triggering malignant hyperthermia. We describe the successful anaesthetic management of a patient with osteogenesis imperfecta, undergoing nephrolithotomy and ureterolithotomy with total intravenous anaesthesia including propofol, remifentanil and cisatracurium, using an intubating laryngeal mask.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/6. Calculus anuria in a spina bifida patient, who had solitary functioning kidney and recurrent renal calculi.STUDY DESIGN: Clinical case report with comments by colleagues from austria, belgium, germany, japan, and poland. OBJECTIVES: To discuss challenges in the management of spinal bifida patients, who have marked kyphoscoliosis and no vascular access. SETTING: Regional spinal injuries Centre, Southport, UK. methods: A female patient, who was born with spina bifida, paraplegia and solitary right kidney, had undergone ileal loop urinary diversion. Renal calculi were noted in 1986. Percutaneous nephrostolithotomy was performed in 1989 and there was no residual stone fragment. However, she developed recurrence of calculi in the lower pole of the right kidney in 1991. Intravenous urography, performed in 1995, revealed right staghorn calculus and hydronephrosis. Chest X-ray showed markedly restricted lung volume due to severe kyphoscoliosis. In 2000, she was declared unsuitable for anaesthesia due to a lack of venous access and a high likelihood of difficulty in weaning off the ventilator in the postoperative period. In June 2002, she developed anuria (urine output=18 ml/24 h) due to ball-valve-type obstruction by a renal stone at the ureteropelvic junction. urea: 14.4 mmol/l; creatinine: 236 microl/l. Ultrasound showed right hydronephrosis. Percutaneous nephrostomy was performed. RESULTS: Following relief of urinary tract obstruction, there was postobstructive diuresis (3765 ml/24 h). However, the patient expired 19 days later due to progressive respiratory failure. CONCLUSION: In this spina bifida patient, who had reached the age of 35 years, severe kyphoscoliosis and lack of vascular access presented insurmountable challenges to implement the desired surgical procedure for removal of stones from a solitary kidney.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
3/6. radial nerve injury after general anaesthesia in the lateral decubitus position.A 43-year-old female patient underwent pyelolithotomy in the left lateral decubitus position. Her upper right arm was placed on a padded armboard. Surgery lasted for 240 min. Postoperatively, she complained of numbness of the dorsal part of her right hand and wrist drop. Neurological examination revealed hypoaesthesia of the dermatome of the right forearm and hand innervated by the radial nerve. electromyography revealed advanced axonal degeneration of the radial nerve below the level of the elbow. Treatment with diclofenac, vitamin B and physiotherapy was started. Her symptoms improved gradually and at the 60th postoperative day, motor weakness had completely resolved. In order to prevent peri-operative nerve injury, careful positioning of every patient on the operating table with proper padding is essential, with attention paid to time-dependent risks. If an injury occurs, diagnosis and treatment should be started as rapidly as possible.- - - - - - - - - - ranking = 0.8keywords = anaesthesia (Clic here for more details about this article) |
4/6. Post-operative paraplegia with spinal myoclonus possibly caused by epidural anaesthesia: case report.We report a patient who developed paraplegia following percutaneous nephrolithotresis of the left kidney under epidural anaesthesia. The cause of the paraplegia was unknown, but occlusion of the anterior spinal artery or central arteries and arachnoiditis, possibly due to the epidural anaesthesia, may have taken part in the onset and progression of the paralysis. The patient had spinal myoclonus corresponding to the spinal levels where myelomalacia was found by magnetic resonance (MR) imaging.- - - - - - - - - - ranking = 1.2keywords = anaesthesia (Clic here for more details about this article) |
5/6. Interpleural block: a new technique for regional anaesthesia during percutaneous nephrostomy and nephrolithotomy.Interpleural block was used in four patients undergoing percutaneous nephrostomy, one of whom also underwent percutaneous nephrolithotomy. Interpleural block was achieved with the standard technique using 30 ml of 0.5 per cent bupivacaine. All patients tolerated the procedure well and remained haemodynamically stable during the operative procedure. Mean pain relief from initiation of interpleural block was ten hours (SD = 4.32). Interpleural block was an effective method of obtaining anaesthesia for percutaneous nephrostomy and nephrolithotomy in these four patients.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
6/6. Epidural opioids as anaesthesia for extracorporeal shock wave lithotripsy in two patients with cardiac disease.Two patients with cardiac disease underwent Extracorporeal shock Wave lithotripsy (ESWL) in the Dornier HM3 machine. In order to minimize cardiovascular changes, epidural opioids (fentanyl 100 micrograms in 10 ml saline was used in one patient and meperidine 50 mg in 10 ml saline in the other patient) were used as an alternative to either general anaesthesia or epidural local anaesthesia. Both patients displayed haemodynamic stability, remained pain-free and experienced no complications. Epidural opioids proved a suitable form of anaesthesia for ESWL in these patients.- - - - - - - - - - ranking = 1.4keywords = anaesthesia (Clic here for more details about this article) |