1/11. Fatal cardiac ischaemia associated with prolonged desflurane anaesthesia and administration of exogenous catecholamines.PURPOSE: Four cardiac ischaemic events are reported during and after prolonged anaesthesia with desflurane. CLINICAL FEATURES: We have evaluated desflurane in 21 consecutive patients undergoing advanced head and neck reconstructive surgery. Four deaths occurred which were associated with cardiac ischaemic syndromes either during or immediately after operation. All patients in the study received a similar anaesthetic. This comprised induction with propofol and maintenance with alfentanil and desflurane in oxygen-enriched air. Inotropic support (either dopamine or dobutamine in low dose, 5 micrograms.kg.min-1) was provided as part of the anaesthetic technique in all patients. Critical cardiovascular incidents were observed in each of the four patients during surgery. These were either sudden bradycardia or tachycardia associated with ST-segment electrocardiographic changes. The four patients who died had a documented past history of coronary heart disease and were classified American Society of Anesthesiologists (ASA) II or III. One patient (#2) did not survive anaesthesia and surgery and the three others died on the first, second and twelfth postoperative days. Enzyme increases (CK/CK-MB) were available in three patients and confirmed myocardial ischaemia. CONCLUSION: These cases represent an unexpected increase in the immediate postoperative mortality for these types of patients and this anaesthetic sequence.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/11. Anaesthesia for caesarean section in a patient with Eisenmenger's syndrome.Eisenmenger's syndrome was originally described in 1897 and redefined by wood in 1958. This syndrome includes pulmonary hypertension with reversed or bi-directional shunt associated with septal defects or a patent ductus arteriosus. A 27-year-old G2 PO with Eisenmenger's syndrome presented to the hospital for management at 17 weeks of pregnancy. She was advised termination of pregnancy but she refused. An elective caesarean section was performed successfully under general anaesthesia uneventfully at 29 weeks due to severe intrauterine growth retardation (IUGR). Patient's postoperative complications like pulmonary thromboembolism, the advantages and disadvantages of anticoagulation are discussed. pregnancy carries substantial maternal and fetal risk for patients with pulmonary hypertension and Eisenmenger's syndrome. Although pregnancy should be discouraged in women with Eisenmenger's syndrome it can be successful.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
3/11. Unmasking of thyrotoxicosis during anaesthesia.Two cases of subclinical and undiagnosed thyrotoxicosis that presented with unexplained tachycardia during surgery are described. Differential diagnosis and logistics in the management of patients presenting with tachycardia, with or without fever during anaesthesia are discussed. It is emphasised that when encountering unexplained tachycardia during anaesthesia, thyrotoxicosis must be suspected. Investigations for thyrotoxicosis must be carried out in the postoperative period.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/11. Acute heart failure during spinal surgery in a boy with Duchenne muscular dystrophy.patients with Duchenne muscular dystrophy (DMD) are at high risk of perioperative complications. DMD may be accompanied by heart failure resulting from dystrophic involvement of the myocardium, which can be subclinical in the early stages of the disease. This case demonstrates that a normal preoperative ECG and echocardiograph cannot exclude the development of heart failure during anaesthesia in DMD patients undergoing major surgery.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
5/11. Anaesthetic management of a parturient with the postural orthostatic tachycardia syndrome: a case report.postural orthostatic tachycardia syndrome encompasses a group of disorders characterized by orthostatic intolerance. We describe the anaesthetic management of analgesia for labour and of Caesarean section in a parturient suffering from this disorder. Worsening of her symptoms during pregnancy was managed with an increase in the dose of beta-blockers taken by the patient. Epidural analgesia was instigated early to attenuate the stress of labour and avoid consequent triggering of a tachycardic response. Slow titration of epidural analgesia and anaesthesia after an adequate fluid preload was undertaken to minimize hypotension and subsequent tachycardia. Neuraxial opioid, combined with non-steroidal anti-inflammatory drugs and bilateral iliohypogastric and ilioinguinal nerve blocks were used to optimize postoperative analgesia.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
6/11. Anaesthetic-induced ventricular tachyarrhythmia in Jervell and Lange-Nielsen syndrome.A four-year-old deaf girl with a history of convulsions developed polymorphous ventricular tachycardia during induction of anaesthesia. The arrhythmia reverted to sinus rhythm spontaneously. Post-anaesthetic ECG showed marked prolongation of the QTc interval (570-690 msec). deafness and prolonged QTc interval in association with microcytic-hypochromic anaemia confirmed the diagnosis of the Jervell and Lange-Nielsen syndrome. This case report highlights the potentially lethal complication of halothane anaesthesia in patients with long QTc interval syndrome.- - - - - - - - - - ranking = 0.33333333333333keywords = anaesthesia (Clic here for more details about this article) |
7/11. Pacemaker-induced tachycardia during general anaesthesia: a case report.Pacemakers with a rate-responsive function, based on calculation of ventilatory minute volume, may induce tachycardia in patients who undergo hyperventilation during general anaesthesia. If hyperventilation is desired, it is recommended that the pacemaker is reprogrammed in order to avoid tachycardia. If the programming device is not available, a magnet may be placed over the pacemaker site to convert it to fixed-rate pacing.- - - - - - - - - - ranking = 0.83333333333333keywords = anaesthesia (Clic here for more details about this article) |
8/11. Haemodynamic disturbances during anaesthesia in a patient receiving calcium channel blockers.Haemodynamic changes (supraventricular tachycardia, decreases in arterial pressure) were observed during laryngoscopy and intubation of the trachea in a patient receiving nifedipine and verapamil. Before the induced stresses of laryngoscopy and tracheal intubation, these drugs had controlled the patient's arterial pressure and heart rate satisfactorily, and possible reasons why this was not so at the commencement of anaesthesia are discussed.- - - - - - - - - - ranking = 0.83333333333333keywords = anaesthesia (Clic here for more details about this article) |
9/11. Severe hypertension and flushing in a patient with a non-metastatic carcinoid tumour. hypertension and flushing with a solitary carcinoid tumour.A case of multiple endocrine adenopathy type I associated with a solitary carcinoid tumour is described. During anaesthesia and characteristic syndrome consisting of hypertension, tachycardia and flushing occurred. The possible mechanism for this are discussed.- - - - - - - - - - ranking = 0.16666666666667keywords = anaesthesia (Clic here for more details about this article) |
10/11. Labour retarded with beta-agonist drugs. A therapeutic problem in emergency anaesthesia.A case of prolapsed umbilical cord is recorded in which an overdose of orciprenaline was given to the mother. The physiological and pharmacological implications to the mother and fetus are discussed and a method of treatment is suggested.- - - - - - - - - - ranking = 0.66666666666667keywords = anaesthesia (Clic here for more details about this article) |
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