1/18. tuberous sclerosis presenting for laparotomy.A 30-year-old female patient with tuberous sclerosis presented for anaesthesia and surgery for haemorrhagic renal angiomyolipoma. The anaesthetic management of this case was tailored to the prevention of seizures. Diagnostic features and possible complications of the disease are also described.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/18. Convulsions following axillary brachial plexus blockade with levobupivacaine.Neurotoxicity manifesting as convulsions is a recognised complication of the administration of local anaesthetic drugs as part of a regional anaesthetic technique. We describe a case of self-limiting convulsions following the institution of an axillary brachial plexus block with levobupivacaine. Although the occurrence of convulsions following the administration of racemic bupivacaine is a well-recognised complication, there have been no clinical case reports published describing convulsions following the use of levobupivacaine in regional anaesthesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/18. Acute toxicity of local anesthetic ropivacaine and mepivacaine during a combined lumbar plexus and sciatic block for hip surgery.hip fracture is a common pathology in elderly patients. Intercurrent diseases, mainly cardiac and respiratory, often result in significant morbidity and mortality. anesthesia for hip fracture can be provided by general or regional techniques. The combination of a lumbar plexus and posterior sciatic nerve block represents an alternative to neuraxial technique of anaesthesia such as spinal anesthesia (4, 6). We report a case of acute toxicity resulting in the injection of local anesthetics Ropivacaine and mepivacaine in elderly patient. An elderly woman was scheduled for surgical repair of a fractured femur neck by dynamic hip screw synthesis. anesthesia was realized by peripheral nerve bi-block (lumbar plexus and posterior sciatic block) (7). The patient experienced seizures and dysrhythmias twenty minutes after block completion and injection of the anesthetic solution [Ropivacaine 0.75%, administered for lumbar plexus block performed via the posterior approach (WINNIE) and mepivacaine 1.5%, administered for posterior sciatic nerve block (LABAT)]. cardiopulmonary resuscitation was successful. All signs of toxicity disappeared after injection of midazolam and atropine, intubation and 100% oxygen ventilation. We decided to proceed with surgery. The postoperative course was uncomplicated and made a full recovery.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/18. Recurrent post-partum seizures after epidural blood patch.There are many causes for headaches after childbirth. Even though postdural puncture headache (PDPH) has to be considered in a woman with a history of difficult epidural anaesthesia, pre-eclampsia should always be excluded as an important differential diagnosis. We report a case with signs of late-onset pre-eclampsia where administration of an epidural blood patch (EBP) was associated with eclampsia. A hypothetical causal relationship between the EBP and seizures was discarded on the basis of evidence presented in this report.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/18. Postoperative pseudoepileptic seizures in a known epileptic: complications in recovery.A 47-yr-old woman underwent general anaesthesia for a squint correction. She had previously suffered a cerebral venous thrombosis, presenting as grand mal seizures during recovery from general anaesthesia for minor surgery. Subsequently, she was affected by Jacksonian limb seizures and petit mal epilepsy and had required long-term rehabilitation, and anticonvulsant and anticoagulant therapy. On arrival in recovery on this occasion, with a laryngeal mask airway (LMA) in place, she started to convulse. The seizures were initially treated with midazolam i.v., but they recurred. Whilst observing the seizure pattern and excluding the differential diagnoses, evidence emerged that psychological factors had played a large part in her clinical picture. Her differential diagnosis had recently been amended to include 'pseudoseizures'. A firm, supportive approach caused the 'convulsions' to cease within a few hours.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
6/18. Convulsions on anaesthetic induction with sevoflurane in young children.Increased worldwide use for paediatric anaesthesia of the volatile anaesthetic agent sevoflurane has mainly resulted from its low blood-gas partition coefficient and low airway irritability, providing smooth conditions for rapid induction of anaesthesia. Nevertheless, there are several clinical and experimental reports suggesting a correlation between exposure to sevoflurane and generalized clonic or tonic seizure activity. We report two clinical episodes of convulsions associated with the induction of sevoflurane anaesthesia in young children. CASE 1: during induction of anaesthesia with sevoflurane by facemask in a 3-year-old healthy boy, there were symmetrical clonic seizure-like movements of the upper extremities for 60 s. CASE 2: on re-induction of anaesthesia with sevoflurane because of profuse bleeding following nasal adenoidectomy in a 4-year-old healthy girl with a family history of epilepsy, there were symmetrical tonic and clonic seizure-like movements for 30-40 s in the upper and lower extremities. Both episodes ceased spontaneously. Although no EEG was recorded, it cannot be excluded that both episodes resulted from seizure activity within the CNS. Based on our observations and reports by others we suggest that, until further notice, sevoflurane should be avoided or at least used cautiously in patients where clinical epileptic activity has been verified or is strongly suspected.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
7/18. Seizure-like movements during induction of anaesthesia with sevoflurane.Clonic and tonic seizure-like movements of the extremities were observed during induction of anaesthesia with sevoflurane in a 9-yr-old girl. The tonic movements were associated with respiratory alkalosis and were not abolished by an i.v. injection of thiamylal 75 mg. arterial pressure, heart rate and body temperature remained normal during the episode. ventilation was assisted easily and then controlled via a face mask. No neurological abnormalities were obvious after the anaesthesia. The movements may have been the result of seizure activity in the central nervous system, or myoclonus of the extremities.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |
8/18. Neurological cause of late postpartum seizures.A 32-year-old primigravida showed signs of pre-eclampsia before delivery of a healthy boy at term. The CSF-space was accidentally punctured during epidural anaesthesia in labour. One day later hypertension was noted and the patient had a single generalized fit. For the next three weeks she had postural headaches, fluctuating hypertension, intermittent hearing loss and double-vision. On the 22nd day of postpartum, the patient had the first of a series of partial and later generalized seizures, followed by hemiparesis, alteration of consciousness, and finally slow recovery with corticosteroid therapy. Bilateral subdural effusions and generalized meningeal thickening were found on MR scans. Repeated MRI excluded sinus thrombosis and documented the response to treatment.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
9/18. Intraoperative defect in haemostasis in a child receiving valproic acid.This report describes the development of an intraoperative defect in haemostasis which occurred during surgery for lengthening of the heel cords and release of hip contractures in a patient receiving valproic acid. A review of the literature failed to find any other cases of a valproic acid-induced bleeding disorder occurring under anaesthesia and surgery. While recognized in the non-surgical literature, this case reports the first in which the development of a valproic acid-induced haemostatic defect occurred under anaesthesia. The subsequent course is discussed and some pathophysiological mechanisms are presented. It is suggested that for patients receiving valproic acid preoperative education should include PT/PTT, platelet and fibrinogen counts and bleeding time so that abnormal coagulation states can be recognized.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
10/18. Asystole with convulsion following a subanesthetic dose of propofol plus fentanyl.A case is presented in which asystole and convulsions occurred after an attempted induction of anaesthesia with propofol and fentanyl. The case suggests that a history of syncope may be associated with unusual susceptibility to the bradycardic effects of propofol.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
| | Next -> |