1/2. Peripartum cardiomyopathy and thromboembolism; anesthetic management and clinical course of an obese, diabetic patient.PURPOSE: To describe the anesthetic management and clinical course of a patient with peripartum cardiomyopathy. We highlight the frequent occurrence of thromboembolic morbidity in this group of parturients, emphasizing the need for early consideration of prophylactic anticoagulation. Clinical features: A 38-yr-old, diabetic, obese parturient was admitted with pulmonary edema and severe orthopnea at 31 weeks gestation. The respiratory rate was 44 breaths x min(-1), blood pressure 110/70 mmHg, pulse 120 beats x min(-1) and rales were heard in both lung fields. The diagnosis of peripartum cardiomyopathy was made based on sinus tachycardia with no evidence of ischemia on the electrocardiogram, and global left ventricular hypokinesis with an ejection fraction of 40-45% noted on transthoracic echocardiography. Cesarean delivery was planned to improve maternal respiratory status and hemodynamics. General anesthesia with invasive monitoring was planned, and surgery and anesthesia proceeded uneventfully. Less than 24 hr postoperatively, she sustained a thrombotic cerebral infarct leaving her hemiparetic and dysarthric. Subsequent investigations revealed a thrombophilic state due to elevated anticardiolipin antibody. CONCLUSION: General anesthesia is an acceptable option in parturients with heart failure secondary to cardiomyopathy. Thromboembolic complications are common, and early consideration should be given to prophylactic anticoagulation.- - - - - - - - - - ranking = 1keywords = thromboembolism (Clic here for more details about this article) |
2/2. Thromboembolic complication after arthroscopic shoulder surgery.Thromboembolic complications after arthroscopic shoulder surgery are very unusual and need thorough investigation of the possible origin. In this case of venous pulmonary thromboembolism after arthroscopy of the shoulder, neither a hint of coagulopathy nor an anatomic abnormality could be found that explains this complication. Therefore, irritation of the subclavian vein caused by compression by the motor-driven shaver is probably one cause for our thromboembolic complication. Careful attention to positioning, fluid management, and use of traction, as well as an appreciation of shoulder anatomy to select portal placement will help decrease the common complications associated with shoulder arthroscopy. A further option to prevent thrombembolic complications in shoulder arthroscopy patients might be prophylaxis with a low-weight heparin in patients with risk factors. In conclusion, awareness of uncommon complications such as deep venous thrombosis and pulmonary embolism will help the orthpaedic surgeon promptly diagnose and treat these problems.- - - - - - - - - - ranking = 0.25keywords = thromboembolism (Clic here for more details about this article) |