1/9. Respiratory arrest after a caudal injection of bupivacaine.A 3.5-year-old child with Cornelia de lange syndrome presenting for orchidopexy and herniotomy received general anaesthesia which was supplemented by a caudal injection of bupivacaine. Shortly after this he had a respiratory arrest with fixed dilated pupils. No cardiovascular system instability was observed. Approximately one hour later the child made a rapid and complete recovery. The possible causes of these events are discussed with particular reference to the potential effects of caudal injections on intracranial pressure.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/9. Anaesthetic considerations in idiopathic orthostatic hypotension and the shy-drager syndrome.Orthostatic hypotension due to autonomic failure may occur secondary to systemic disease states (notably diabetes) or as a disease entity in its own right with a variable degree of neurological involvement that has resulted in a confused classification. The diagnosis, classification and treatment of these latter forms of orthostatic hypotension is reviewed. The pathology is in the central and efferent autonomic pathway, resulting in a disordered baro-receptor reflex, postural hypotension, abnormal responses to tilting and the Valsalva manoeuvre, an inappropriately fixed heart rate and other autonomic features. Anaesthesia may be associated with profound hypotension and some of the signs of anaesthesia may be absent. The response to cardiac depressant drugs and reduction of circulating blood volume may be exaggerated due to absence of compensatory mechanisms. The response to vasoactive agents is unpredictable. The importance of preoperative evaluation, monitoring during operation and the careful selection of anaesthetic agents and techniques is discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/9. 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) |
4/9. Cutaneous anaesthesia in necrobiosis lipoidica.Cutaneous sensation in plaques of necrobiosis lipoidica was assessed in five non-diabetic and seven diabetic patients. Eleven of the twelve showed partial or complete anaesthesia of the affected skin. These findings are important in the differential diagnosis of tuberculoid leprosy. Further studies of nerve function in cutaneous granulomas need to be carried out.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
5/9. diagnosis of infantile neuroaxonal dystrophy by conjunctival biopsy.Conjunctival biopsy and ultrastructural examination of conjunctival nerves, showing the presence of spheroids within axons, led to the confirmation of the diagnosis of infantile neuroaxonal dystrophy in two children with progressive mental deterioration. Conjunctival biopsy, which is simple to perform, even in young children, and does not require general anaesthesia or admission to hospital, is presented as a reliable and very convenient technique for the diagnosis of infantile neuroaxonal dystrophy.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
6/9. Malignant histiocytosis and encephalomyeloradiculopathy complicating coeliac disease.A 62 year old Irish woman with an eight year history of probable coeliac disease developed brain stem signs, unilateral facial numbness and weakness, wasting and anaesthesia in both lower limbs. Over the next two years, a progressive deterioration in neurological function and in intestinal absorption, and the development of anaemia led to a suspicion of malignancy. bone marrow biopsy revealed malignant histiocytosis. Treatment with cytotoxic drugs led to a transient, marked improvement in intestinal structure and function, and in power of the lower limbs. Relapse was associated with bone marrow failure, resulting in overwhelming infection. Post mortem examination confirmed the presence of an unusual demyelinating encephalomyelopathy affecting the brain stem and the posterior columns of the spinal cord.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
7/9. Reconstruction of a defect of the ala nasi following trigeminal anaesthesia with an innervated forehead flap.A 47-year-old man with a 15 year history of unilateral, idiopathic trigeminal anaesthesia presented with trophic ulceration of the right ala nasi and had a successful nasal reconstruction performed using an innervated left forehead flap. Three years later the cosmetic results is satisfactory and the flap retains normal sensation.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
8/9. Unexpected neurological deficits following recovery from anaesthesia.Two cases of neurological dysfunction are presented. Neurological deficits after recovery from anaesthesia are unusual in young women perioperatively. In the first case, a 39-yr-old woman presented at 36-wk gestation with antepartum haemorrhage and in labour. pregnancy had been complicated by pre-eclampsia and she underwent emergency Caesarean section under general anaesthesia without complication. The trachea was extubated when she was awake but almost immediately she became hypertensive, obtunded and reintubation was required. Her pupils became fixed and dilated but the Computerised Axial Tomogram (CT) was normal. A coagulopathy was evident. She made a full neurological recovery within 24 hr. On the same day, a previously healthy 41-yr-old woman who had undergone uneventful surgery for uterine prolapse 24 hr previously developed headache, nausea and over the next four hours signs of progressive brainstem ischaemia. The CT scan showed oedema of the mid- and hindbrain. Brainstem death was confirmed 12 hr later and the post-mortem revealed acute dissection of the vertebral artery secondary to cystic medial necrosis. Such dramatic neurological sequelae are rare but the importance of identifying "at risk" groups is underlined as is early recognition of neurological injury postoperatively.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |
9/9. A transient neurological deficit following intrathecal injection of 1% hyperbaric bupivacaine for unilateral spinal anaesthesia.We describe a case of transient neurological deficit that occurred after unilateral spinal anaesthesia with 8 mg of 1% hyperbaric bupivacaine slowly injected through a 25-gauge pencil-point spinal needle. The surgery and anaesthesia were uneventful, but 3 days after surgery, the patient reported an area of hypoaesthesia over L3-L4 dermatomes of the leg which had been operated on (loss of pinprick sensation) without reduction in muscular strength. sensation in this area returned to normal over the following 2 weeks. Prospective multicentre studies with a large population and a long follow-up should be performed in order to evaluate the incidence of this unusual side effect. However, we suggest that a low solution concentration should be preferred for unilateral spinal anaesthesia with a hyperbaric anaesthetic solution (if pencil-point needle and slow injection rate are employed), in order to minimize the risk of a localized high peak anaesthetic concentration, which might lead to a transient neurological deficit.- - - - - - - - - - ranking = 7keywords = anaesthesia (Clic here for more details about this article) |