1/5. Intubating laryngeal mask and rapid sequence induction in patients with cervical spine injury.The Intubating Laryngeal Mask (FastrachTM), a modified conventional laryngeal mask airway, and its prototype cuffed silicone tube, continue to be an appropriate intubating tool in combination with fibreoptic bronchoscopy in the emergency situation. This is an account of two patients with suspected cervical spine fracture admitted to our emergency room in a haemodynamically unstable condition and requiring a rapid sequence induction of anaesthesia, in whom we successfully applied this newly developed intubating device for the first time. Provided that there are no intubation difficulties, direct laryngoscopy is still the fastest method of securing an airway; however, this procedure leads to an extension of the cervical spine, which may be hazardous in the case of a cervical spine injury. intubation by means of the Intubating Laryngeal Mask avoids dangerous hyperextension of the occipito-atlanto-axial complex, a fact that we were able to verify by lateral cervical spine fluoroscopy during intubation.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/5. Immediate endovascular stent-graft repair of an acute traumatic rupture of the thoracic aorta: case report and subject review.We describe a case of emergency endovascular stent-graft placement for acute traumatic rupture of the thoracic aorta in a patient with an associated unstable type II odontoid fracture. The stent-graft placement procedure was performed within 4 hours of admission under sedation and local anaesthesia while the neck remained externally splinted. After exclusion of the rupture the patient could then undergo treatment of the associated cervical fracture and other injuries.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/5. Successful treatment of a chronic post-traumatic 5-year-old osteoporotic vertebral compression fracture by percutaneous vertebroplasty.Osteoporotic vertebral compression fracture (VCF) is a frequently encountered clinical problem associated with chronic pain and disability. Conservative treatment in the form of bed rest, pain control and bracing may create a vicious circle, in which reduced activity leads to further reduction in bone density and fracture risk. Percutaneous vertebroplasty (PVP) is an accepted treatment modality for osteoporotic vertebral body collapse present for less than 1 year, vertebral myeloma, haemangioma, metastasis and recent traumatic fractures (between 3 and 12 months). We describe an osteoporotic patient in whom successful PVP was performed, under general anaesthesia using CT and fluoroscopic guidance, in a post-traumatic 5-year-old VCF with complete alleviation of debilitating pain. In the light of our experience, we suggest that PVP should be carried out in a series of similar patients to asses its value as a treatment option in patients with chronic osteoporotic vertebral fractures for pain relief and improvement in mobility, independent of fracture age.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/5. Hangman's fracture in a paediatric patient: considerations for anaesthesia.Cervical spine injuries are quite uncommon in children. When occurring, these lesions are of particular concern for the anaesthesiologist. This case refers to an hangman's fracture diagnosed in a four-month-old female infant, which probably occurred at birth. We describe the anaesthetic management adopted in this infant undergoing diagnostic procedures and conservative treatment. The problems related to airway control and the anaesthetic management utilized to diagnose and treat this unusual paediatric pathology are highlighted.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
5/5. Massive bleeding during spine surgery in a patient with ankylosing spondylitis.PURPOSE: Ankylosing spondylitis is associated with pathophysiology that has important anaesthetic implications. We report a case where the sequelae of ankylosing spondylitis may have been responsible for massive bleeding during emergency spine surgery. CLINICAL FEATURES: A 69 yr old man with long standing ankylosing spondylitis sustained a complex fracture of the lumbar spine in a fall, and was scheduled for stabilization of the spine. Under general anaesthesia, prone positioning was difficult because of the extreme spinal deformity. During exploration, dilatation of epidural veins was encountered and sustained haemorrhage was encountered throughout the surgical procedure. Estimated blood loss was 17,000 ml which was replaced with 31 units of packed red blood cells, 3200 ml of salvaged blood, 18 units of fresh frozen plasma, 26 units of platelets, 1,000 ml of albumin and 9,000 ml of crystalloid. CONCLUSIONS: Extreme deformity of the spine led to positioning difficulties that may have contributed to massive blood loss during complex spine surgery. Difficulties with placement in the prone position in-patients with advanced ankylosing spondylitis should be anticipated.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |