1/8. Pulmonary lipiodol embolism during transcatheter arterial chemoembolization for hepatoblastoma under general anaesthesia.We present a case of pulmonary embolism that occurred during the injection of lipiodol during transcatheter arterial chemoembolization under general anaesthesia. A 7-year-old child suffering from a large hepatoblastoma was admitted for arterial chemoembolization and carcinostatic administration. pulmonary embolism due to lipiodol during arterial chemoembolization was evident by a sudden fall in oxyhaemoglobin saturation from 100 to 90%. This was associated with a spread of lipiodol into both lungs, particularly the middle lung zones and detected by chest fluoroscopy. Arterial blood gases returned to normal values 1 day later but pulmonary infiltration persisted for 7 days before final clearance. pulmonary embolism caused by lipiodol during arterial chemoembolization is infrequent, but such a complication could prove fatal. Understanding the risk of pulmonary embolism in patients receiving lipiodol, during and after arterial chemoembolization, and late onset pulmonary injury is important and a close follow-up for several days after arterial chemoembolization is advisable.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/8. radio-frequency ablation of hepatic metastases from colorectal cancer.BACKGROUND: The aim of our study is to present the preliminary results of an ongoing radio-frequency (RF) ablation study in patients with hepatic metastases from colorectal cancer. patients AND methods: From November 2003, two patients affected with metachronous liver metastases from colorectal cancer were treated with RF ablation. The mean age of the patients was 66 years (58 and 74 years). Tumours were unifocal right-lobe lesions in one patient and bifocal in the second patient. Under general anaesthesia, a Radionics 200-W RF generator was used to ablate lesions with H2O-cooled electrodes via laparotomy. patients' follow-up ranged from two to five months including evaluation of salient clinical, radiological and laboratory parameters. RESULTS: The patients experienced moderate-to-severe pain in the right abdomen lasting for 2-3 days and mild fever for 3-6 days after treatment. During the follow-up period no local recurrence was observed. CONCLUSIONS: RF ablation emerges to be a promising method for the treatment of hepatic metastases from colorectal cancer.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
3/8. somatostatin, anaesthesia, and the carcinoid syndrome. Peri-operative administration of a somatostatin analogue to suppress carcinoid tumour activity.A patient with carcinoid syndrome on long-term antiserotonin therapy with parachlorophenylalanine, experienced a flushing attack with hypotension during the prophylactic administration of aprotonin prior to the induction of anaesthesia. When she was subsequently prepared with a long-acting somatostatin analogue, octreotide (Sandostatin, Sandoz SMS 201-995), plasma levels of tumour-released hormones were reduced and anaesthesia for resection of hepatic metastases was uneventful. The advantages of an anaesthetic approach based on inhibition of carcinoid tumour activity, rather than antagonism of released hormones, are discussed.- - - - - - - - - - ranking = 1.2keywords = anaesthesia (Clic here for more details about this article) |
4/8. Severe hypercalcaemia due to a parathyroid-type hormone-secreting tumour of the liver treated by hepatic transplantation. A rare combination of biochemical problems and discussion of their management.It is very rare for a patient to have to be submitted for surgery and anaesthesia with severe hypercalcaemia unresponsive to medical treatment. Problems which may be anticipated are hypertension, hypotension, cardiac dysrhythmias and renal failure. Anaesthesia for liver transplantation also requires a full appreciation of the biochemical, haematological and haemodynamic problems involved. In the present report a patient scheduled for hepatic transplantation had a consistently raised serum calcium level (4 mmol/litre) due to the secretion of a parathyroid-type hormone by hepatic tumour cells. The pre-operative management of hypercalcaemia and intra- and postoperative management of liver transplantation in this patient are presented and discussed.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
5/8. Anaesthetic management of a patient with carcinoid tumor undergoing myocardial revascularization.Carcinoid tumors with hepatic involvement can produce intense flushing, tachycardia, hypotension or hypertension and diarrhoea. patients with limited cardiac reserve may not tolerate these effects under anaesthesia. Valvular heart disease associated with carcinoid tumors has been reported, but there is no record in the literature of such an association with coronary artery disease. This report presents the anaesthetic management of a patient with coronary artery disease and carcinoid tumor undergoing myocardial revascularization. Emphasis is placed on the rational use of anaesthetic and adjunctive agents which will minimize the incidence of carcinoid symptons. The salient features of the management are prevention of release of vasoactive substances by the use of promethazine hydrochloride during operation, the avoidance of stropine, prophylactic administration of corticosteroids and smooth induction of anaesthesia by the use of diazepam and dimethyl-tubocurarine iodide (Metocurine).- - - - - - - - - - ranking = 0.4keywords = anaesthesia (Clic here for more details about this article) |
6/8. Carcinoid syndrome in a diabetic patient.A diabetic patient who subsequently developed carcinoid syndrome is described. The responses to the anaesthetic technique and drugs used demonstrated the interactions of serotonin and bradykinin. Undiagnosed carcinoid syndrome can simulate an anaphylactic reaction under general anaesthesia.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
7/8. vocal cord paralysis associated with difficult gastric tube insertion.Many clinical reports have described vocal cord paralysis after general anaesthesia. In most cases, paralysis was attributed to tracheal tube insertion. In this report we describe one patient in whom gastric tube insertion was strongly suspected as the cause of paralysis. The patient was a 47-yr-old man who underwent left hepatic lobectomy. Just after the operation he complained of hoarseness and a diagnosis of complete right vocal cord paralysis was made, from which he recovered after eight weeks. In this patient, insertion of the gastric tube seemed to have injured the anterior ramus of the right recurrent laryngeal nerve directly. Although there have been several reports of vocal cord paralysis induced by gastric tubes, none has noted such an acute onset and direct nerve injury. Therefore we would like to report this rare case and elucidate the mechanism of vocal cord paralysis. Careful attention should be paid in inserting a gastric tube to patients under general anaesthesia and, sometimes, the use of the soft tube may be indicated.- - - - - - - - - - ranking = 0.4keywords = anaesthesia (Clic here for more details about this article) |
8/8. Unusual presentation of phaeochromocytoma. Management of anaesthesia and cardiovascular monitoring.A case is reported in which a patient with a history of high output left ventricular failure presented for exploratory laparotomy and removal of a highly vascular tumour which was intra-operatively discovered to be a phaeochromocytoma.- - - - - - - - - - ranking = 0.8keywords = anaesthesia (Clic here for more details about this article) |