1/3. baroreflex function in a patient with Bartter's syndrome.There is little information regarding circulatory responses in Bartter's syndrome, with the exception of marked resistance to vasopressors. We investigated baroreflex function in a 40-year-old woman with this syndrome. The patient showed oscillation of heart rate even with a small increase in blood pressure after administration of vasopressor agents. Variations in heart rate and blood pressure were exaggerated during halothane, nitrous oxide and oxygen anaesthesia. Although the mechanism of the unstable baroreflex in this syndrome remains to be proved, the instability may be attributable to many factors such as prostaglandins, hypovolemia, hypokalemia, halothane, nitrous oxide and positive pressure ventilation.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. shy-drager syndrome. A review and a description of the anaesthetic management.Autonomic failure in patients with the shy-drager syndrome may produce cardiovascular instability during anaesthesia and surgery. The syndrome is reviewed and the anaesthetic management of a case is described. The choice between general and regional anaesthesia seems to be less important than adequate cardiovascular monitoring and the maintenance of blood pressure with intravenous fluids. Sympathomimetic drugs, if used at all, should be administered in very dilute solutions to avoid hypertension from denervation hypersensitivity. In the postoperative period, symptoms from orthostatic hypotension may be severe and their control requires prolonged postural training, by elevation of the head of the bed, and therapy with 9-alpha-fludrocortisone.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
3/3. Management of ureteric calculi during pregnancy by ureteroscopy and laser lithotripsy.OBJECTIVE: To evaluate the efficacy and safety of ureteric stone treatment by ureteroscopy and laser lithotripsy during pregnancy. patients AND methods: Four pregnant women (mean age 29.5 years, range 27-35) with five episodes of ureteric stones were treated by ureteroscopy and laser lithotripsy when the fetus was at 26-35 weeks of gestation. The stones (between 5 and 16 mm in diameter) were located in the proximal (one) or distal ureter (four). RESULTS: All five stones were removed successfully by ureteroscopy and laser lithotripsy. The operating time varied between 15 and 70 min. In two of the five cases, topical anaesthesia was adequate and in no case was fluoroscopy necessary. No complications occurred that could be related to the procedure. CONCLUSIONS: ureteroscopy and laser lithotripsy seem, in experienced hands, to be a safe and reliable method in the treatment of ureteric calculi during pregnancy. Most cases can be treated without using fluoroscopy and in some cases the operation can be performed under local anaesthesia.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |