1/16. paraplegia after thoracotomy--not caused by the epidural catheter.BACKGROUND: paraplegia and peripheral nerve injuries may arise after general anaesthesia from many causes but are easily ascribed to central block if the latter has been used. CASE REPORT: A 56-yr-old woman, with Bechterev disease but otherwise healthy, was operated with left-sided thoracotomy to remove a tumour in the left lower lobe. She had an epidural catheter inserted in the mid-thoracic area before general anaesthesia was started. bupivacaine 0.5% 5 ml was injected once and the infusion of bupivacaine 0.1% with 2 micrograms/ml fentanyl and 2 micrograms/ml adrenaline (5 ml/h) started at the end of surgery. The patient woke up with total paralysis in the lower limb and sensory analgesia at the level of T8, which remained unchanged at several observations. laminectomy, performed 17 h after the primary operation, showed a large piece of a haemostatic sponge (Surgicel) compressing the spinal cord, which was then decompressed but the motor and sensory deficit remained virtually unchanged both then and a year later. CONCLUSIONS: This case shows--once again--that although central blocks may cause serious neurological complications and paraplegia, other causes are possible and have to be considered. However, all patients with an epidural catheter must be monitored for early signs and symptoms of an intraspinal process and the appropriate treatment has to be instituted instantly.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/16. Target-controlled intravenous anaesthesia with bispectral index monitoring for thoracotomy in a patient with severely impaired left ventricular function.The anaesthetic management of an elderly patient with severely impaired left ventricular function undergoing thoracotomy and lobectomy is described. Total intravenous anaesthesia (TIVA) with remifentanil and target-controlled infusion of propofol titrated according to the bispectral index (BIS) was used, with thoracic epidural anaesthesia commenced at the end of surgery providing postoperative analgesia. Avoidance of intraoperative epidural local anaesthetics and careful titration and dose reduction of propofol using the BIS was associated with excellent haemodynamic stability. The rapid offset of action of remifentanil and low-dose propofol facilitated early recovery and tracheal extubation. The BIS was a valuable monitor in optimal titration of TIVA.- - - - - - - - - - ranking = 3keywords = anaesthesia (Clic here for more details about this article) |
3/16. Nasopharyngeal carcinoma with distant metastasis.We report a case of nasopharyngeal carcinoma with Chest Metastasis in a 38-year-old man. The patient presented with nasal obstruction, epistaxis, a huge neck mass and conductive hearing loss in the right ear. Examination under anaesthesia revealed a mass in the nasopharynx, which was confirmed on histology to be squamous carcinoma. He responded remarkably well to external radiotherapy with disappearance of primary tumor and neck metastasis. One year later he presented with thoraco-lumbar spine pain and cough. The nasopharynx and neck remained free of tumor while radiographs demonstrated multiple metastasis to the lungs and vertebrae.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
4/16. Negative pressure pulmonary oedema in the medical intensive care unit.OBJECTIVE: Negative pressure pulmonary oedema (NPPE) occurring in the medical intensive care unit (MICU) is an uncommon, probably under-diagnosed, but life-threatening condition. DESIGN: Retrospective data collection. SETTING: Medical intensive care unit in a 1,500-bedded tertiary care hospital. patients AND PARTICIPANTS: Five patients were diagnosed between January 1998 and January 2002. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Five patients were diagnosed to have NPPE from different aetiologies. These were acute epiglottitis, post-stenting of right bronchus intermedius stenosis, strangulation, compression from a goitre and one patient developed diffuse alveolar haemorrhage after biting the endotracheal tube during recovery from anaesthesia. All patients responded rapidly to supplemental oxygen, positive pressure ventilation and correction of underlying aetiologies. Pulmonary oedema resolved rapidly. CONCLUSIONS: There is a large spectrum of aetiologies causing NPPE in the medical intensive care unit.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
5/16. Palliative surgery of acrometastases from lung cancer: a case report.A clinical case of a woman with lung cancer and a very painful bone metastases of the phalangette of the 4th finger of the right hand (acrometastases) is described. Palliative radiation on the 4th finger was not indicated due to almost complete bone destruction. Both patient and daughter refused administration of strong opioids, such as morphine, for pain management, due to fear of addiction and of opioid-related adverse effects. Phalangectomy, with palliative intent, was performed under local anaesthesia, in day surgery, resulting in complete pain relief.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
6/16. Contralateral tension pneumothorax during thoracotomy for lung resection.A patient underwent right thoracotomy and upper lobectomy for a mass found on routine chest radiography. He became profoundly cyanosed with a bradycardia and severe reduction in oxygen saturation at completion of surgery. The diagnosis of tension pneumothorax on the contralateral side to surgery was made and treatment instituted. The causes, treatment and implications of such an event during general anaesthesia for lung resection are discussed.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
7/16. Anaesthetic management for oophorectomy in pulmonary lymphangiomyomatosis.Pulmonary lymphangiomyomatosis is an idiopathic disease, resulting in severe respiratory impairment. Bilateral oophorectomy has led to objective and subjective amelioration of the pulmonary pathology. In the anaesthetic management of such a patient, careful attention must be paid to pulmonary and systemic haemodynamics, and gas exchange. We describe the successful anaesthetic management of a 34-year-old female, using epidural anaesthesia, and pulmonary artery catheterization. Although the intraoperative and immediate postoperative courses were heralded by marked cardiorespiratory stability, refractory respiratory failure developed, and she died five months after surgery.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
8/16. bleomycin therapy and anaesthesia. The possible hazards of oxygen administration to patients after treatment with bleomycin.bleomycin is a cytotoxic drug used in the treatment of teratoma of the testis. This drug appears to sensitize the lungs so that acute lung damage occurs with concentrations of oxygen normally considered free from toxic effects. Two anaesthetics administered to the same patient undergoing thoracotomy are reported. No postoperative lung damage was produced on either occasion.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
9/16. Continuous in-vivo monitoring of arterial oxygen tension in a patient treated with bleomycin.patients receiving bleomycin therapy may develop pulmonary fibrosis. The risk of fibrosis is increased by the administration of general anaesthesia and fatal cases with pulmonary lesions resembling those of "oxygen toxicity" have been reported. The causes are not entirely clear but the enriched inspired oxygen given intraoperatively or postoperatively has been identified as an etiological factor. Optimal intraoperative management thus requires the administration of the lowest inspired oxygen fraction (FIO2) compatible with adequate oxygenation. To achieve this aim safely, continuous in vivo monitoring of arterial oxygen tension would be preferable to intermittent sampling of blood gases. We report the successful management of a patient undergoing thoracotomy following bleomycin therapy using an intravascular PO2 sensor to monitor arterial oxygen tension continuously. The uses and limitations of the PO2 sensor are discussed.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
10/16. Insertion of a self-expandable endotracheal metal stent using topical anaesthesia and a fibreoptic bronchoscope: a comfortable way to offer palliation.A self-expandable stent was used to obtain prolonged relief of stridor resulting from tracheal obstruction by extrinsic tumour compression despite prior external irradiation. The stent was inserted in an easy and comfortable procedure with fibreoptic bronchoscopy under local anaesthesia.- - - - - - - - - - ranking = 2.5keywords = anaesthesia (Clic here for more details about this article) |
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