1/159. paraplegia after thoracotomy--not caused by the epidural catheter.BACKGROUND: paraplegia and peripheral nerve injuries may arise after general anaesthesia from many causes but are easily ascribed to central block if the latter has been used. CASE REPORT: A 56-yr-old woman, with Bechterev disease but otherwise healthy, was operated with left-sided thoracotomy to remove a tumour in the left lower lobe. She had an epidural catheter inserted in the mid-thoracic area before general anaesthesia was started. bupivacaine 0.5% 5 ml was injected once and the infusion of bupivacaine 0.1% with 2 micrograms/ml fentanyl and 2 micrograms/ml adrenaline (5 ml/h) started at the end of surgery. The patient woke up with total paralysis in the lower limb and sensory analgesia at the level of T8, which remained unchanged at several observations. laminectomy, performed 17 h after the primary operation, showed a large piece of a haemostatic sponge (Surgicel) compressing the spinal cord, which was then decompressed but the motor and sensory deficit remained virtually unchanged both then and a year later. CONCLUSIONS: This case shows--once again--that although central blocks may cause serious neurological complications and paraplegia, other causes are possible and have to be considered. However, all patients with an epidural catheter must be monitored for early signs and symptoms of an intraspinal process and the appropriate treatment has to be instituted instantly.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/159. Fatal cardiac ischaemia associated with prolonged desflurane anaesthesia and administration of exogenous catecholamines.PURPOSE: Four cardiac ischaemic events are reported during and after prolonged anaesthesia with desflurane. CLINICAL FEATURES: We have evaluated desflurane in 21 consecutive patients undergoing advanced head and neck reconstructive surgery. Four deaths occurred which were associated with cardiac ischaemic syndromes either during or immediately after operation. All patients in the study received a similar anaesthetic. This comprised induction with propofol and maintenance with alfentanil and desflurane in oxygen-enriched air. Inotropic support (either dopamine or dobutamine in low dose, 5 micrograms.kg.min-1) was provided as part of the anaesthetic technique in all patients. Critical cardiovascular incidents were observed in each of the four patients during surgery. These were either sudden bradycardia or tachycardia associated with ST-segment electrocardiographic changes. The four patients who died had a documented past history of coronary heart disease and were classified American Society of Anesthesiologists (ASA) II or III. One patient (#2) did not survive anaesthesia and surgery and the three others died on the first, second and twelfth postoperative days. Enzyme increases (CK/CK-MB) were available in three patients and confirmed myocardial ischaemia. CONCLUSION: These cases represent an unexpected increase in the immediate postoperative mortality for these types of patients and this anaesthetic sequence.- - - - - - - - - - ranking = 3keywords = anaesthesia (Clic here for more details about this article) |
3/159. Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report.BACKGROUND: The short term experience of endovascular treatment of abdominal aortic aneurysms (AAA) seems promising but long term randomised data are lacking. Consequently, cases treated by endovascular procedures need to be closely followed for potential risks and benefits. CASE REPORT: A 70 year-old mildly hypertensive male without previous or present arteriosclerotic, pulmonary, or urological manifestations was subjected to endovascular treatment after his mass-screening diagnosed abdominal aortic aneurysm had expanded to above 5 cm in diameter, the aneurysm having been found by CT-scanning and arteriography to be endovascularly treatable. A Vanguard bifurcated aortic stent graft was implanted under epidural/spinal anaesthesia and covered by cephalosporine and heparin (8000 IE) protection. Apart from treatment of a groin haematoma and stenosis of the left superficial femoral artery, the postoperative period presented no problems. A few days before the monthly follow-up visit, the patient developed uraemia, gangrene of one foot and dyspnoea. blood glucose and LDH was elevated. Deterioration led to death a month and a half after stent implantation. autopsy showed extraordinary large, extensive soft, brown vegetations in the lower part of the thoracic aorta above the properly infrarenally-placed stent. Microscopic examination revealed multiple microemboli in the liver, spleen, pancreas, intestines, testes, and especially the kidneys. DISCUSSION: Early death from microemboli after aortic stent implantation has been reported. However, the present case developed fatal multiple microemboli so late that they could not have originated from the excluded mural thrombus. The sudden death of an otherwise healthy man of extensive microemboli is difficult to explain. The stent application may have altered the proximal flow and wall movements disposing to microemboli in the case of vegetations.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
4/159. Chronic subdural haematoma following caesarean section under spinal anaesthesia.Intracranial subdural haematoma is a rare complication of spinal anaesthesia. This report describes the case of a 31-year-old woman who presented with post partum headache following spinal anaesthesia for caesarean section. Bilateral haematomata were evacuated via burr-holes performed under total intravenous anaesthesia and the patient made a complete and uneventful recovery. The recognized causes of subdural haematoma are discussed.- - - - - - - - - - ranking = 3.5keywords = anaesthesia (Clic here for more details about this article) |
5/159. Diaphragmatic rupture after epidural anaesthesia in a patient with diaphragmatic eventration.An 85-year-old man with undiagnosed eventration of the left hemidiaphragm had an above-knee amputation under epidural anaesthesia. His post-operative course was stormy with two episodes of cardiovascular collapse. On the third post-operative day, rupture of the left hemidiaphragm was diagnosed, the bowel had herniated into the left hemithorax. It is proposed that the left hemidiaphragm ruptured spontaneously because of muscular weakness secondary to the thoracic segmental blockade associated with lumber epidural anaesthesia.- - - - - - - - - - ranking = 3keywords = anaesthesia (Clic here for more details about this article) |
6/159. Postoperative delirium indicating an adverse drug interaction involving the selective serotonin reuptake inhibitor, paroxetine?We report a postoperative delirium expressed by a 49-year-old female patient during recovery from anaesthesia. Prominent features of the delirium, which lasted for nearly 2 days, included agitation, confusion, uncontrolled limb movements, abnormal ocular function, hypertension, pyrexia, brisk reflexes, ankle clonus and raised creatine kinase. The delirium did not respond to naloxone, diazepam or flumazenil. The patient had not been prescribed neuroleptics but, before surgery, she had been taking the selective serotonin reuptake inhibitor, paroxetine, to relieve her depression. During surgery, she was given morphine, which increases release of the neurotransmitter, serotonin, and ondansetron, which blunts neuronal release of dopamine. Although there is no clear explanation for the delirium, it had many features in common with problems associated with paroxetine withdrawal, the serotonin syndrome and the malignant neuroleptic syndrome. We offer several alternative explanations for this event, all of which rest on disruption of serotonergic and/or dopaminergic transmission and which could also involve inhibition by paroxetine of the P450 enzyme, CYP2D6, which metabolizes ondansetron.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
7/159. Acute horner syndrome due to thoracic epidural analgesia in a paediatric patient.A 4-year-old boy with coarctation of the aorta underwent surgical aortic arch repair with general anaesthesia and thoracic epidural analgesia. In the immediate postoperative period, the child developed a unilateral horner syndrome which appeared to be related to the epidural infusion rate. Management of this patient as well as alternate aetiologies of horner syndrome are described. horner syndrome is a rare complication of epidural catheters and is often unrecognized, especially in children.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
8/159. Can a dose of 2microg.kg(-1) caudal clonidine cause respiratory depression in neonates?A case of multiple life-threatening postoperative apnoeas in a term neonate undergoing inguinal herniorrhaphy and orchidopexy who received light inhalation anaesthesia combined with caudal block with 1 ml.kg-1 ropivacaine 0.2% plus 2 microg.kg-1 clonidine is reported. The patient showed no apparent risk factors for postanaesthetic apnoea. Oxycardiorespirography five days after surgery only showed minor abnormalities. clonidine though administered caudally in the usual dose of 2 microg.kg-1 appeared to be the most likely cause for postanaesthetic apnoea in this neonate.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
9/159. Undiagnosed central anticholinergic syndrome may lead to dangerous complications.This report describes two cases of central anticholinergic syndrome, the first after general anaesthesia and the other during a prolonged stay in the intensive care unit. The symptoms in both patients resolved soon after physostigmine administration. There was a delay in the diagnosis of central anticholinergic syndrome, which resulted in acute lung injury and unanticipated intensive care unit admission. It is suggested that in cases of abnormal mental recovery after anaesthesia or sedation, the diagnosis of central anticholinergic syndrome should be considered.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
10/159. Anaesthetic management of a patient with low tracheal obstruction requiring placement of a T-Y stent.A 60-year-old man with a history of oesophagectomy for carcinoma presented with worsening dysphagia, dyspnoea and tachypnoea secondary to oesophageal stricture and tumour invasion of the trachea causing a "ball-valve" obstruction. The patient required placement of a T-Y tracheobronchial stent to relieve the airway obstruction and was successfully managed using sevoflurane for gaseous induction followed by maintenance with propofol total intravenous anaesthesia.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
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