1/3. A technique of anaesthesia in haemorrhagic shock. Illustrative case histories and a discussion.The anaesthetic management of patients in haemorrhagic shock is described. The principles are those of initial resuscitation with electrolyte solutions and alleviation of metabolic acidosis, combined with early induction of anaesthesia to permit control of bleeding as soon as possible. The anaesthetic technique depends on pre-oxygenation, intravenous anaesthesia, muscular relaxation and ventilation with pure oxygen. Earlier cases were induced with thiopentone and maintained with intermittent suxamethonium, but intravenous ketamine was later employed for induction and intramuscular ketamine for maintenance; this use of ketamine is now the author's method of choice. The use of a central venous pressure line connected to a cannula in the internal jugular vein is recommended.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Haemostasis by angiographic embolisation in exsanguinating haemorrhage from facial arteries. A report of 2 cases.life-threatening exsanguinating haemorrhage from arteries of the face following trauma is uncommon. When it occurs it is often located in the relatively inaccessible parts of the vessels and requires deep face or neck exploration and ligation of the main feeding vessel. The procedure requires expert head and neck vascular surgery performed under general anaesthesia, which is often not suitable in these haemodynamically unstable patients. In addition, surgery is often rendered more difficult by the associated post-traumatic swelling and disfigurement. Because of these considerations, angiographic embolisation of the bleeding vessels was performed as an alternative to surgical exploration. This report illustrates its use in achieving haemostasis in 2 patients.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
3/3. retinopathy of prematurity in infants of birth weight > 2000 g after haemorrhagic shock at birth.BACKGROUND: The risk of retinopathy of prematurity (ROP) is associated with low birth weight and low gestational age. For ROP screening examination is recommended in infants weighing < or = 1500 g or of less than 32 weeks' gestational age. methods: From 1991 ROP screening was performed in 452 premature infants with either a birth weight < or = 1500 g (n = 303) or a birth weight > 1500 g (n = 149) and who required additional oxygen supplementation or underwent surgery with general anaesthesia before estimated term. RESULTS: Unexpectedly, three infants with birth weights between 2080 and 2325 g and a gestational age of 32 or 33 weeks developed stage 2 or 3 ROP. One of these underwent cryocoagulation. In three infants, preterm birth was induced by sudden placental abruption with severe prenatal blood loss followed by haemorrhagic shock. The umbilical cord packed cell volume was reduced to 0.14-0.19 (normal 0.43-0.63). All three infants underwent surgery with general anaesthesia within the first weeks of life. Of the remaining 449 infants none with a birth weight > 1650 g developed any stage of ROP. CONCLUSION: Severe prenatal blood loss requiring blood transfusions and surgery with general anaesthesia may induce higher stages of ROP even in infants with birth weights exceeding the usual screening criteria.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |