1/6. Epidural haematoma after dural puncture in a parturient with neurofibromatosis.A case of epidural analgesia in a parturient with neurofibromatosis (von Recklinghausen's disease) complicated by dural puncture and epidural haematoma is described and the management of the case is discussed. The case emphasizes the need for antenatal assessment of parturients with neurofibromatosis in order that the necessary investigations can be arranged and informed consent for analgesia and anaesthesia can be obtained.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/6. Upper airway obstruction in neurofibromatosis.A patient with von Recklinghausen's neurofibromatosis developed severe upper airway obstruction at the induction of anaesthesia and required emergency cricothyroidotomy. The cause was a neurofibroma at the base of the tongue. Features of von Recklinghausen's neurofibromatosis which may be of importance to the anaesthetist are reviewed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/6. Epidural analgesia for labour in a parturient with neurofibromatosis.The first report of epidural analgesia for labour in a 26-yr-old woman with von Recklinghausen's neurofibromatosis is described. Epidural anaesthesia is often considered as contraindicated because neurofibromas may involve spinal cord and nerve roots. However, general anaesthesia was considered at high risk for this parturient on the basis of her previous medical and surgical history and of physical findings. The present observation suggests that epidural analgesia may be used in such circumstances provided that spinal cord neurofibromas have been ruled out by clinical and CT scan (or magnetic resonance imaging) examination.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
4/6. Anaesthetic difficulties in neurofibromatosis.Difficulties with general and regional anaesthesia in a patient with neurofibromatosis due to involvement of larynx and possibly also of the spinal column with tumour are described. The difficulties with anaesthesia due to neurofibromatosis are reviewed, and it is concluded that, while the majority of cases will present no problems, careful pre-operative assessment is of vital importance.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
5/6. Management of the difficult airway. A case of failed fiberoptic intubation.BACKGROUND: Fiberoptic intubation is the current gold standard for the management of difficult intubation. Nevertheless, in rare circumstances even fiberoptic intubation fails. methods: We describe the case of a female patient suffering from neurofibromatosis Recklinghausen and a giant malignant schwannoma on the neck obstructing the pharynx and compromising respiration. Based on the clinical presentation and the MRI findings, difficulties in airway management were anticipated and fiberoptic intubation of the awake patient was planned. RESULTS: After localizing the vocal cords it was not possible to advance the tube into the trachea due to the severe deviation of the glottis. A decision was made to cancel any further fiberoptic intubation attempts and a conventional tracheotomy was performed under local anaesthesia without problems. CONCLUSION: This case illustrates that even awake fiberoptic intubation has its failure rate, due to inability to visualize the larynx, inability to advance the tube over the fiberscope (as in the present case), or inability to direct the tube towards the larynx. Due to the extreme deviation of the larynx other established techniques for difficult intubation were not deemed appropriate in this case. Therefore, weighing the risks and benefits, a decision was made to perform a tracheotomy under local anaesthesia.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
6/6. Cerebral aneurysm associated with von Recklinghausen's neurofibromatosis: a case report.BACKGROUND: von Recklinghausen's neurofibromatosis is a hereditary disease that may affect any organ or system of the body primarily or secondarily, including the vascular system. Among the rare cerebrovascular abnormalities, the most common is stenosis or occlusion of the cerebral artery. Intracranial aneurysms are uncommon. CASE DESCRIPTION: A case of an intracranial cerebral aneurysm associated with von Recklinghausen's neurofibromatosis is reported. A 55-year-old woman presented with a history of intermittent headache for 2 months and right oculomotor nerve palsy for 1 month. Widespread cutaneous neurofibromas and angiomas were found over her trunk and limbs with prominent cafe-au-lait spots. X-ray showed that her left lung was compressed by a large mass in the left chest with rib defects and lateral spinal curvature. Right internal carotid angiography revealed a saccular aneurysm between C1 and C2. craniotomy to clip the aneurysm could not be performed because the mass in her chest made intubation for general anaesthesia almost impossible. CONCLUSION: The clinical features of this case are discussed together with a review of 15 similar cases in the literature. There are different theories about this disorder. We agree that the malformations are derived not only from ectodermal, but also from mesodermal pathology. In terms of our case, we consider the progression of this disease to be slow.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |