1/3. Mechanical obstruction to ventilation from an ovarian cyst during pregnancy.This report documents the danger of the gravid uterus fixing a large ovarian cyst in a position disadvantageous to diaphragmatic excursion and thereby obstructing ventilation. A 34-year-old pregnant patient presented at 18 weeks amenorrhoea with a large ovarian cyst. She gave a history of exertional dyspnoea and orthopnoea. Clinical examination revealed a grossly enlarged abdomen and a respiratory rate of 28 breaths.min-1. Intraoperatively, ventilation was markedly impaired resulting in cyanosis and bradycardia. This was relieved by drainage of the ovarian cyst. A left lateral tilt with manual traction on the tumour may have avoided this problem. Should the above measures be inadequate, immediate drainage of the cyst is essential. Severe respiratory distress may require ultrasound-guided, percutaneous, aspiration of the cyst preoperatively. However, as in this patient, the absence of gross signs of respiratory failure does not preclude acute ventilatory failure after induction of anaesthesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Asystole during spinal anaesthesia after change from Trendelenburg to horizontal position.We present a case in which progressive bradycardia and sudden cardiac arrest developed in a 26-year-old healthy woman with an ovarian cyst during spinal anaesthesia, immediately after the patient was moved from the 15 degree Trendelenburg to the supine horizontal position. We postulate that a decrease in venous return was the main cause of the cardiac arrest. It should be stressed again that close monitoring during spinal anaesthesia is essential when the patient is subjected to postural changes.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |
3/3. Same day drainage and removal of a giant ovarian cyst.PURPOSE: An unusual case of a giant ovarian cyst was successfully anaesthetized with a combination of epidural followed by general anaesthesia. The method was chosen to avoid circulatory depression and re-expansion pulmonary oedema in removal of a giant tumour in a woman who did not understand the nature of her disease. CLINICAL FEATURES: A 58-yr-old woman (107.6 kg, 150 cm and abdominal girth: 163.5 cm) was admitted for removal of a giant ovarian cyst. There was gross-pitting oedema of both legs and an elevated diaphragm but no pleural effusion. She did not understand the severity of her disease. It was decided to drain the cyst gradually, followed by total surgical removal on the same day. An epidural catheter was inserted at the L3-4 interspace with the patient in the left lateral position and, under epidural anaesthesia, 44.3 L fluid were drained over two hours without producing circulatory depression or pulmonary oedema. General anaesthesia was induced, with the patient in the supine position, by slow injection of 10 mg midazolam, 100 micrograms fentanyl and inhalation of nitrous oxide 50% in oxygen, and maintained with adding epidural block using lidocaine 1.5% and bupivacaine 0.5%, and sevoflurane 0.4 to 0.8%. During surgery, the volume of infused fluid was carefully controlled with central venous pressure monitoring. Ulinastatin, a protease inhibitor, was infused to prevent pulmonary oedema. No circulatory depression nor pulmonary oedema occurred perioperatively. CONCLUSION: For the removal of a giant ovarian cyst, slow drainage over two hours under epidural anaesthesia may safely precede later removal of the cyst on the same day under general anaesthesia.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |