1/10. Successful management of massive blood loss to extremely low hemoglobin in an elderly woman receiving spinal surgery.blood transfusion is absolutely indicated in acute anemia when the hemoglobin concentration falls below 6 g/dL. Sometimes it challenges the anesthesiologists if the blood intended for urgent transfusion is not readily or quickly available. In this case report, we describe an 81-year-old lady who accidentally sustained acute anemia after spinal surgery with the hemoglobin concentration falling to 1.4 g/dL. During the long wait for the process of cross-matching tests and delivery of blood from the blood bank in the city remote from the hospital, we could do nothing but administer crystalloid and colloid solutions to maintain the circulatory volume to prevent low cardiac output. epinephrine was given when systolic blood pressure fell below 70 mmHg. central venous pressure and arterial blood pressure were monitored to guide all the treatment. Fortunately, patient fully recovered on postoperative day 3 without any adverse events.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/10. Cerebellar haemorrhage after supratentorial aneurysm surgery with lumbar drainage.Haemorrhage within the posterior fossa (PF) after supratentorial surgery is a very rare and exceedingly dangerous complication. Only 28 cases were found in the literature. Up to now, no pathogenetic factor has decisively proven to be the cause of this phenomenon. We present clinical details of a patient operated on for aneurysm of the anterior communicating artery. Lumbar drainage was used during surgery, with the loss of a large amount of cerebrospinal fluid (200 ml). Other causes in our case which may have led to cerebellar shift or a critical increase in transmural venous pressure with subsequent vascular disruption and haemorrhage were extreme head rotation during lengthy surgery and blood pressure peaks in the early postoperative period. Repeated computed tomography (CT) allowed immediate diagnosis of this complication and control of its conservative management. After postponed ventriculoperitoneal shunt, the patient recovered completely.- - - - - - - - - - ranking = 0.66666666666667keywords = pressure (Clic here for more details about this article) |
3/10. Hemorrhagic cyst following remote alloplastic implantation for orbital floor fracture repair.Hemorrhagic cyst formation may occur within months or years following repair of orbital fractures with alloplastic materials. patients present with a sensation of pressure in the involved orbit, double vision, and globe displacement. Evaluation must rule out infectious, inflammatory, and vascular etiologies. Computerized tomography scans reveal a soft tissue density surrounding the alloplastic implant. drainage of the cyst and fibrous capsule, with excision of the capsule and removal of the alloplastic implant, is curative. This article presents three clinical cases, highlighting the evaluation and management of this postsurgical development. Use of the protocol described resulted in complete resolution of all clinical symptoms, and the CT scans were normal. As these materials will continue to be utilized, surgeons should be aware of this potential delayed complication and its management.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
4/10. Spinal subdural haematoma mimicking tethered cord after posterior fossa open surgery.We report the MRI findings in a girl aged 3 years and 10 months who developed a spinal subdural haematoma after posterior fossa open surgery for cerebellar malignant rhabdoid tumour. Emergency surgery was performed immediately because of increased intracranial pressure. Control MRI 48 h after surgery showed a spinal subdural haematoma without clinical signs of paresis or bladder dysfunction. Spinal subdural haematoma is rare, and only few cases have been reported, especially in children. This report suggests that "silent" (without clinical symptoms) postoperative spinal acute subdural haemorrhage can occur after posterior fossa surgery.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
5/10. The inadvisability of thoracoscopic lung biopsy on patients with pulmonary hypertension.The use of video-assisted thoracoscopic surgery (VATS) sometimes leads to additional and unnecessary risks compared with thoracotomy. We report a troubling case of VATS lung biopsy in a 43-year-old woman with mild pulmonary hypertension. A progressive elevation of pulmonary artery pressure (PAP) was noted after the commencement of right unilateral ventilation. When the systolic PAP reached 90 mm Hg (390 min after induction of anesthesia), a massive blood discharge through the chest drain occurred. At repeat thoracotomy, continuous blood spouting was seen from > 10 of the surgical sites. It was supposed that the endoscopic staplers were unable to maintain hemostasis with such a high PAP.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
6/10. A case of hepatic artery embolization and partial arterialization of the portal vein for intraperitoneal, hemorrhage after a pancreaticoduodenectomy.We report a case of hepatic artery embolization and partial portal vein arterialization for the treatment of a delayed massive hemorrhage after a pancreaticoduodenectomy. A 70-year-old male underwent a pancreaticoduodenectomy for the treatment of lower bile duct cancer. A slight discharge of pancreatic juice was recognized early during the postoperative period. A delayed massive hemorrhage occurred on postoperative day 34, resulting in hypotensive shock. angiography and computed tomography examinations revealed bleeding from a pseudoaneurysm at the stump of the gastroduodenal artery and portal vein compression by the hematoma. Embolization of the stump of the gastroduodenal artery resulted in the total occlusion of the hepatic artery. We performed a partial portal vein arterialization via side-to-side anastomosis of a branch of the ileal artery and vein. The partial portal oxygen pressure increased from 70 mmHg to 90 mmHg. A liver abscess was recognized two weeks after the arterialization, but was successfully treated by percutaneous transhepatic drainage. The patient was discharged from hospital in good condition on postoperative day 69. Whether the partial portal vein arterialization was effective is unclear, but partial portal vein arterialization should be considered as an option in cases of total hepatic artery occlusion with impairment of portal blood flow.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
7/10. Childhood airway manifestations of lymphangioma: a case report.lymphangioma is a congenital malformation of the lymphatic system, often involving areas of the head and neck. The involved structures may include enlarged tongue and lips, swelling of the floor of the mouth, and direct involvement of the upper respiratory tract. The definitive treatment for lymphangioma is surgery, often during the first years of life. Despite surgical removal, lymphangioma may persist. Anesthetic concerns include bleeding, difficulty visualizing the airway, extrinsic and intrinsic pressure on the airway causing distortion, and enlarged upper respiratory structures, including the lips, tongue, and epiglottis. This is a case report of a 9-year-old patient with lymphangioma who had impacted teeth and a suspected odontogenic cyst. There seems to be little information on the optimal anesthetic management for this age group. The challenges with airway management, including bleeding, laryngospasm, and a difficult intubation, are outlined. awareness of potential airway involvement and possible complications is necessary to provide a safe anesthetic to a patient with lymphangioma. A review of the literature, airway management techniques, and current airway equipment will be discussed.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
8/10. survival after massive bleeding into the airway in a patient at risk from "can't intubate, can't ventilate".A patient survived massive bleeding into the airway due to blowout of the right internal jugular vein associated with a failed free-flap graft for pharyngeal malignancy. A recently decannulated "covering tracheostomy" could not be easily re-established. Direct laryngoscopy and mask ventilation were inappropriate because the pharyngeal mucosal wound opened spontaneously and progressively and bleeding was dramatic. Positive pressure ventilation via a facemask risked widespread surgical emphysema and further wound disruption and because bleeding was from the internal jugular vein, there would also have been a risk of air embolism. The clinical situation evolved rapidly so time management and consideration of hierarchy of mortality risks was critical. It was eventually possible to re-establish the previous tracheostomy site as a result of close co-operation between the surgical and anaesthetic teams. In difficult intubation where the problems are anticipated, the notion of responsive contingency planning is suggested to be of more general relevance than the current standard of considering alternative fallback options. The limitations of conventional capnography in this situation are also noteworthy.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
9/10. Management and prevention of cardiovascular hemorrhage associated with mediastinitis.OBJECTIVE: To elucidate the causes of cardiovascular hemorrhage associated with mediastinitis and to review recommendations for prevention and treatment. SUMMARY BACKGROUND DATA: Mediastinal debridement with immediate or early coverage using healthy, vascularized tissue has lead to greatly reduced morbidity and mortality for patients with mediastinitis. Myocardial hemorrhage has been anecdotally reported. patients AND methods: Over a 36-month period, 7 patients developed massive cardiovascular bleeding after undergoing debridement for poststernotomy mediastinitis. Causes included puncture or erosion by a sternal edge in three and tearing at the myocardial-sternal interface in four. RESULTS: Five patients survived and remain infection-free at an average of 24 months of follow-up. In these patients, ventricular defects were closed with pledgeted sutures and muscle transposition was used concomitantly to reinforce the repair. This involved a slide of the left pectoralis major muscle and turnover of the right pectoralis in three patients, bilateral sliding in one patient, and bilateral pectoralis and an omental flap in one patient who required additional coverage of the lower mediastinum. CONCLUSIONS: When a patient who has undergone mediastinal debridement shows evidence of significant bleeding, we recommend application of pressure for control of hemorrhage, expeditious return to an operating room with available cardiopulmonary bypass, and immediate muscle coverage with healthy, well-vascularized tissue. Finally, early sternectomy might largely prevent this life-threatening complication.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
10/10. Bleeding following retropubic prostatectomy: simple digital rectal pressure could be lifesaving.PURPOSE: A technique to control venous bleeding after retropubic prostatectomy is described. MATERIALS AND methods: A man underwent retropubic prostatectomy for an enlarged benign prostate following which hemorrhage occurred. RESULTS: After failure of other more traditional methods of hemostasis, the bleeding was stopped by direct anterior digital rectal pressure. CONCLUSIONS: Simple digital rectal pressure is a safe, effective and logical method of controlling venous bleeding from the dorsal venous or other plexus between the rectum and symphysis pubis.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
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