1/2. Cerebral complications following induced hypotension.Over an 8-year period (1977-1984), 1,802 otorhinolaryngological procedures were performed under controlled hypotension. Four patients showed symptoms of cerebral damage post-operatively. One patient had pre-operative unrecognized stenosis of the internal carotid artery, another a hypoplastic vertebral artery. In this female patient, the head had been strongly rotated to the side to expose the surgical field, and the internal jugular vein removed. She died of general ischaemic brain damage on the seventh post-operative day. In the remaining two patients, symptoms of cerebral ischaemia did not occur until the third and eleventh day, respectively, so that the causative role of hypotensive anaesthesia is uncertain. The cases described represent a cerebral morbidity of 4:1,802 (0.22%) and a mortality of 1:1,802 (0.06%). It is concluded that controlled hypotension is a safe technique if the indication is stringently applied, and any risk-bearing factors are carefully excluded.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/2. Deliberate hypotension in ENT surgery.The development of deliberate hypotension for ENT surgery is described. A hitherto unrecorded case of paraplegia complicating hypotensive anaesthesia is reported. The use of sodium nitroprusside as a hypotensive agent is assessed. Indications and contraindications to deliberate hypotension are reviewed. Possible neurological damage is considered.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |