1/4. Bilateral tension pneumothorax following rigid bronchoscopy: a report of an epignathus in a newborn delivered by the EXIT procedure with a fatal outcome.We describe a case of a newborn baby with a prenatal diagnosis of an epignathus (oropharyngeal teratoma). With the potential for airway problems at birth, he was delivered by an elective EXIT (Extra Utero Intrapartum Treatment) procedure at 38 weeks of pregnancy. The airway was secured and rigid bronchoscopy performed. Initially he was stable, but developed cardiorespiratory difficulties 40 minutes after birth and died from a cardiac arrest 17 minutes later. Tension pneumothorax is a devastating complication that can occur with lower airway manipulation for anaesthesia and rigid bronchoscopy. The addition of positive pressure during mechanical ventilation converts the pneumothorax into a tension pneumothorax. The possibility of tension pneumothorax should be entertained in a mechanically ventilated patient whose ventilatory pressures are increasing, with diminishing cardiac output. A complicated case is presented, where the diagnosis was missed with a fatal outcome.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/4. dermoid cyst of the tongue: an association of dermoid cyst with bronchogenic epithelium.A congenital dermoid together with a bronchogenic cyst of the tongue is extremely rare. The diagnosis made in this case of a 1-year-old boy was "teratoid cyst of the tongue". A surgical exploration was performed under general anaesthesia via a midline sagittal glossotomy. The tumour was completely dissected and excised, the microscopical examination of the surgical specimen revealed multiple cystic cavities lined by a keratinized squamous epithelium with skin appendages and fatty tissue. Others were composed of cylindrical, ciliated epithelial cells of respiratory type. This is the third reported case in the world literature. All cases were reviewed and compared with this case.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/4. bleomycin therapy and anaesthesia. The possible hazards of oxygen administration to patients after treatment with bleomycin.bleomycin is a cytotoxic drug used in the treatment of teratoma of the testis. This drug appears to sensitize the lungs so that acute lung damage occurs with concentrations of oxygen normally considered free from toxic effects. Two anaesthetics administered to the same patient undergoing thoracotomy are reported. No postoperative lung damage was produced on either occasion.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
4/4. Continuous in-vivo monitoring of arterial oxygen tension in a patient treated with bleomycin.patients receiving bleomycin therapy may develop pulmonary fibrosis. The risk of fibrosis is increased by the administration of general anaesthesia and fatal cases with pulmonary lesions resembling those of "oxygen toxicity" have been reported. The causes are not entirely clear but the enriched inspired oxygen given intraoperatively or postoperatively has been identified as an etiological factor. Optimal intraoperative management thus requires the administration of the lowest inspired oxygen fraction (FIO2) compatible with adequate oxygenation. To achieve this aim safely, continuous in vivo monitoring of arterial oxygen tension would be preferable to intermittent sampling of blood gases. We report the successful management of a patient undergoing thoracotomy following bleomycin therapy using an intravascular PO2 sensor to monitor arterial oxygen tension continuously. The uses and limitations of the PO2 sensor are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |