1/2. Midline prolapse of a lumbar intervertebral disc with compression of the cauda equina.Midline prolapse of a disc causing compression of the cauda equina is rare but needs urgent diagnosis and surgical treatment. The onset of bladder and rectal paralysis with saddle anaesthesia should be viewed with a high index of suspicion in a patient with backache and sciatica. Eight cases were seen over a period of five years, and they fell into three clinical groups. Group I patients presented with a sudden onset without any previous symptoms related to the back. Group II patients had a history of recurrent episodes of backache and sciatica, the latest episode resulting in involvement of the cauda equina. The group III patient was indistinguishable from one with a tumour as he presented with backache and sciatica slowly progressing to paralysis of the cauda equina. The prolapse was at the disc between L5 and S1 vertebrae in 50 per cent of the patients, most of whom did not have any limitation of straight leg raising. Urgent myelography and equally urgent removal of the disc within two weeks of the onset of the symptoms resulted in almost complete motor and bladder recovery within five months after the operation in most cases. However, recovery of sensation and sexual function was incomplete even four years after the operation.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/2. Sudden bradycardia and asystole in an obese patient after spinal anaesthesia: successful resuscitation with inadvertent "pacing thumps.".A 45-year old morbidly obese man with diabetes and severe chest problem had sudden bradycardia and sinus arrest in the Recovery Ward after an uneventful spinal anaesthesia. He responded promptly to "attempts" at external cardiac message with each thump producing a QTS complex until atropine could be given to restore sinus rhythm. The possible causes of the episode and the usefulness of pacing thumps are discussed. Some implications for developing countries who are encouraging spinal anaesthesia are also discussed.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |