1/16. Lower limb exsanguination and embolism.We report a case of fatal pulmonary embolism during lower limb exsanguination in orthopaedic surgery. A 76-year-old woman underwent an open fixation of an external femoral condyle fracture one day after injury. Subarachnoidal anaesthesia was performed and Esmarch compression bandages were applied in preparation for tourniquet ischaemia. At this time, the patient lost consciousness, became apneic and collapsed. resuscitation procedures were instituted and transoesophageal echocardiography revealed pulmonary embolism. In spite of haemodynamic support and thrombolytic therapy, the patient died. Postmortem examination revealed multiple thromboemboli of recent origin in the right heart cavities, in the pulmonary arteries and in the popliteal and tibial veins of the injured leg. Preventive, diagnostic and therapeutic options of this catastrophic event and indications of pulmonary embolectomy are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/16. Pulmonary lipiodol embolism during transcatheter arterial chemoembolization for hepatoblastoma under general anaesthesia.We present a case of pulmonary embolism that occurred during the injection of lipiodol during transcatheter arterial chemoembolization under general anaesthesia. A 7-year-old child suffering from a large hepatoblastoma was admitted for arterial chemoembolization and carcinostatic administration. pulmonary embolism due to lipiodol during arterial chemoembolization was evident by a sudden fall in oxyhaemoglobin saturation from 100 to 90%. This was associated with a spread of lipiodol into both lungs, particularly the middle lung zones and detected by chest fluoroscopy. Arterial blood gases returned to normal values 1 day later but pulmonary infiltration persisted for 7 days before final clearance. pulmonary embolism caused by lipiodol during arterial chemoembolization is infrequent, but such a complication could prove fatal. Understanding the risk of pulmonary embolism in patients receiving lipiodol, during and after arterial chemoembolization, and late onset pulmonary injury is important and a close follow-up for several days after arterial chemoembolization is advisable.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
3/16. A follow up report: recurrent Cushing's syndrome after bilateral adrenalectomy.This is a case report of a 23 year old female. She had earlier been diagnosed to have Cushing's syndrome due to macronodular adrenal hyperplasia, for which bilateral adrenalectomy was performed three years before. The initial full recovery was sustained for about one and a half years, following which there was progressive recurrence of obesity, hypertension and hypercalcaemia. plasma cortisol concentrations were markedly elevated and a diagnosis of recurrent Cushing's syndrome was made. Pre-operative localisation of the source of hypercortisolism through intravenous urogram, abdominal ultrasonogram and computerised tomogram was unfruitful, thus an exploratory laparatomy was undertaken. At surgery, extensive and dense adhesions were seen which caused difficult dissection and accidental injury to the patient's liver and kidney, necessitating massive intra-operative blood transfusions. The patient died within two hours of recovery from anaesthesia of acute massive pulmonary embolism. We postulate that the recurrent Cushing's syndrome in this patient could have been due autografting of remnants of adrenal tissue within the abdominal cavity. A pre-operative localisation with radio-labelled cholesterol scanning may have made reoperation of the patient easier.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/16. Fatal intra-operative pulmonary embolism following application of an Esmarch bandage.The objective of this paper is to raise the awareness of a possible fatal complication during operations in the lower limbs, when an Esmarch bandage is used for exsanguination of the affected limb during the operation. After reviewing the literature, four cases of fatal massive pulmonary embolism have been identified after Esmarch bandage application in trauma patients [Acta Anaesthesiol Belg 50(2) (1999) 95, Reg. Anaesth 6 (1983) 83, anesthesiology 58 (1983) 373, Anaesthesia 25(3) (1970) 445] but there is no any reference to an elective case. The authors would like to report two cases of fatal embolism after Esmarch bandage application for both elective surgery (total knee replacement) and trauma (trimalleolar fracture). Both patients had received regional anaesthesia. After comparing the data from our cases and the literature, it is recommended that the Esmarch bandage should not be used in trauma, especially when there has been a delay in time for surgery. In elective cases of the lower limbs, preoperative cardiovascular evaluation and the exclusion of other factors predisposing to DVT are necessary, especially for patients more than 50 years old.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/16. Experience with the Cardial inferior vena cava filter as prophylaxis against pulmonary embolism in pregnant women with extensive deep venous thrombosis.OBJECTIVE: To report the use of the Cardial inferior vena caval filter as prophylaxis against pulmonary embolism in pregnant women with extensive iliofemoral thrombosis. SETTING: Leicester Royal Infirmary. SUBJECTS: Four pregnant women with extensive iliofemoral thrombosis, deemed to be at high risk of pulmonary embolism, managed over a period of one year. TECHNIQUE: In addition to standard full anticoagulation with heparin, the Cardial inferior vena cava filter was introduced percutaneously under local anaesthesia through the unaffected contralateral femoral vein and positioned in the inferior cava below the renal veins. RESULTS: The procedure was uncomplicated and did not compromise feto-maternal condition. There was no evidence of pulmonary embolism after filter insertion. CONCLUSION: The use of inferior vena cava filters should be considered as an adjunct to intravenous anticoagulation in pregnant women with extensive deep vein thrombosis of the lower limbs.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
6/16. Transoesophageal echocardiography during removal of a caval filter in a patient at high risk of massive pulmonary thromboembolism.A new type of vena caval filter was to be removed from a woman who had a high risk of massive pulmonary thromboembolism because of extensive thrombus in the iliac vein incorporating the filter. The removal was performed under general anaesthesia in the cardiac operating theatre using transoesophageal echocardiography to monitor the right heart and the pulmonary artery during the critical phase of removal. The manoeuvre succeeded with only insignificant embolisation occurring, and that was identified by transoesophageal echocardiography.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
7/16. Fatal pulmonary embolism following spinal anaesthesia for caesarean section.pulmonary embolism remains one of the commonest causes of maternal death. Regional blockade is reported to decrease the incidence of postoperative thrombo-embolic disease. We describe a case in which a fatal pulmonary embolism followed an emergency Caesarean section for which the patient was given a spinal anaesthetic. We believe it to be the first time this has been reported.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
8/16. Anaesthetic considerations in a patient with right heart thrombi-in-transit.This is a case report of a patient with underlying pulmonary thromboembolism who was diagnosed as having a large, mobile right heart thrombi while undergoing treatment with low-molecular weight heparin. She underwent emergency embolectomy with exploration of the right heart under a cardiopulmonary bypass (CPB). Soon after induction of anaesthesia, the patient had an episode of severe hypotension, which responded to inotropes. Large, serpiginous thrombi were found in the right atrium extending into the right ventricle and pulmonary arteries, which were evacuated. She was weaned off CPB on inotropic support and was extubated uneventfully on the 4th POD. Postoperatively, she was started on anticoagulant therapy and also underwent placement of a Greenfield inferior vena caval (IVC) filter to prevent further thromboembolic episodes.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
9/16. Technique of anaesthesia in pulmonary hypertension and thrombophilia in early pregnancy.Pulmonary hypertension in pregnancy is a rare condition but is associated with a high mortality. We report the case of a 29 year old female in early pregnancy with protein c and S deficiency with recurrent deep venous thrombosis and pulmonary embolism and subsequent secondary pulmonary hypertension. The patient was counselled and consented for termination of pregnancy with tubal sterilization. She was administered continuous spinal anaesthesia with invasive monitoring. The successful anaesthetic management of this condition is described.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
10/16. life-threatening complications during anaesthesia in a patient with a ventriculo-atrial shunt and pulmonary hypertension.A 6-year-old patient with hydrocephalus who underwent revision of a ventriculo-atrial shunt is described. Anaesthesia was complicated by the occurrence of systemic hypertension and arterial hypoxaemia. The patient was subsequently found to have pulmonary hypertension secondary to recurrent pulmonary thromboembolism. The pathophysiological mechanisms for the patient's deterioration are discussed and the anaesthetic management of children with pulmonary hypertension is outlined. It is concluded that patients with a ventriculo-atrial shunt who present for surgery should be screened carefully for the presence of pulmonary hypertension.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
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