1/2. Ipsilateral thoraco-lumbar anaesthesia and paravertebral spread after low thoracic paravertebral injection.We report ipsilateral thoraco-lumbar anaesthesia and paravertebral spread of contrast after injection through a thoracic paravertebral catheter that was placed at the right T8-9 spinal level for pain management in a patient with multiple fractured ribs. We review the literature and describe the subendothoracic fascial communication between the thoracic paravertebral space and the retroperitoneal lumbar paravertebral region, which we propose, is the anatomical basis for ipsilateral thoraco-lumbar anaesthesia and paravertebral spread of contrast in our patient.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/2. Bilateral first rib fractures associated with driver's air bag inflation: case report and implications for surgery.A case of bilateral fractures of the first rib occurring in an otherwise fit road traffic accident victim is described. The only other injuries sustained were of the peripheral limbs. The driver's air bag was inflated during the crash, leading to speculation as to whether this may have contributed to the mechanism of injury. The patient was well oxygenated and cardiovascularly stable with no evidence of neurovascular damage to the thoracic aorta or its branches. Aortic arch aortography was not performed before internal fixation of the peripheral fractures was undertaken under general anaesthesia. A review of the indications for angiography in such patients follows. The policy that patients with fractures of the upper first ribs do not require angiography unless there is other evidence of neurovascular damage is supported.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |