1/5. 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) |
2/5. Diffuse pulmonary infiltrates in immunocompromised patients.The differential diagnosis of bilateral interstitial pulmonary infiltrates in immunocompromised patients is very extensive. We describe two immunocompromised patients with diffuse pulmonary infiltrative changes. Bronchoscopic bronchoalveolar lavage after orotracheal intubation using topical anaesthesia combined with mild sedation in an ICU setting is safe in critically ill patients and often yields a conclusive diagnosis.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/5. Cardiovascular collapse caused by carbon dioxide insufflation during one-lung anaesthesia for thoracoscopic dorsal sympathectomy.carbon dioxide insufflation into the pleural space during one-lung anaesthesia for thoracoscopic surgery is used in some centres to improve surgical access, even though this practice has been associated with well-described cardiovascular compromise. The present report is of a 35-year-old woman undergoing thoracoscopic left dorsal sympathectomy for hyperhidrosis. During one-lung anaesthesia the insufflation of carbon dioxide into the non-ventilated hemithorax for approximately 60 seconds, using a pressure-limited gas inflow, was accompanied by profound bradycardia and hypotension that resolved promptly with the release of the gas. Possible mechanisms for the cardiovascular collapse are discussed, and the role of carbon dioxide insufflation as a means of expediting lung collapse for procedures performed using single-lung ventilation is questioned.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |
4/5. Anaesthesia for cholecystectomy in two non-parturients with Eisenmenger's syndrome.Eisenmenger's syndrome consists of high pulmonary vascular resistance with reversed or bidirectional shunt at aortopulmonary, ventricular or atrial level. We describe the anaesthetic management of two adult females with Eisenmenger's syndrome admitted for laparoscopic cholecystectomy. One patient suffered post-operative complications, but the other case was uncomplicated. We used sevoflurane and total intravenous anaesthesia to provide general anaesthesia. Both techniques were tolerated.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
5/5. Anaphylactoid reaction to maltose 5% solution during spinal anaesthesia.PURPOSE: A rare case of an anaphylactoid reaction to maltose solution is presented. CLINICAL FEATURES: A 28-yr-old man underwent repair of bilateral inguinal hernia under spinal anaesthesia with dibucaine. At the end of operation, he developed generalized flush and circulatory collapse immediately after receiving Na acetate solution containing maltose, 5%, i.v. The reactions were treated with 32 mg ephedrine and 250 mg methylprednisolone i.v., and rapid infusion of 1,000 ml acetated Ringer's solution. The skin tests provoked positive responses to maltose solutions. CONCLUSION: The clinical features and skin tests suggested that the episode was an anaphylactoid reaction to maltose. maltose is one of the dissacharides (MW: 342) produced from starch and glycogen. maltose solutions are used frequently in japan as a carbohydrate source. Further study is required to confirm whether maltose has an immunological antigen-eliciting activity.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |