1/9. 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) |
2/9. Loss of consciousness following spinal anaesthesia for caesarean section.A healthy parturient under spinal anaesthesia for Caesarean section lost consciousness for an hour, 20 min after the intrathecal injection of 2 ml of 0.5% heavy bupivacaine. The patient was haemodynamically stable before losing consciousness. The differential diagnosis is discussed.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
3/9. hysteria. A cause of failure to recover after anaesthesia.hysteria as a cause of failure to recover consciousness following general anaesthesia is a rare event. This case report describes such an instance in a young, healthy 22-year-old female suffering severe dental phobia who was undergoing dental conservation. The literature is reviewed and a summary of the possible physiological mechanisms involved is given.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
4/9. Failure to awaken after general anaesthesia secondary to paradoxical venous embolus.A patient is presented who failed to regain consciousness after an apparently uneventful nine-hour revision of a total hip replacement. There were no clinically important haemodynamic changes during the operation, and oxygen saturation, capnography and acid base balance were normal throughout. Postop CT of the head showed a large left MCA infarct with midline shift. At autopsy, the patient was found to have a previously unsuspected patent foramen ovale, and a venous embolus in the left internal carotid artery, which probably had originated from the periprostatic venous plexus with a large infarct in the distribution of the left anterior and middle cerebral arteries. The authors conclude that massive paradoxical venous emboli can occur during surgery with minimal haemodynamic changes.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
5/9. Loss of consciousness after emergence from anaesthesia. A case of suspected micturition syncope.A case of postanaesthesia micturition syncope with respiratory arrest is described. If syncope occurs, the temporary myocardial ischaemia and cerebral hypoperfusion may increase anaesthetic risk in the marginally compensated patient. The loss of airway protection during the syncopal period is also a cause of concern. We recommend the use of an indwelling bladder catheter during any prolonged surgical procedure.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
6/9. Apnoea and unconsciousness after apparent recovery from alfentanil-supplemented anaesthesia.Several cases of recurrent respiratory depression progressing to apnoea and unconsciousness after apparent recovery from sufentanil have been reported recently. alfentanil has the shortest elimination half-time of the narcotics used in anaesthesia, suggesting that it should be the least likely to cause postoperative respiratory depression. A case of recurrent unconsciousness and respiratory arrest after apparent recovery from alfentanil-isoflurane-nitrous oxide anaesthesia is reported. A total dose of 137 micrograms.kg-1 alfentanil was given over a 3.25-hr period to a 45-year-old female undergoing partial gastrectomy. naloxone, 0.16 mg IV, rapidly restored spontaneous ventilation and consciousness. This case demonstrates that apnoea and unconsciousness can also recur after apparent recovery from alfentanil. recovery room personnel should be aware of this phenomenon. Earlier detection may permit treatment before apnoea occurs. patients given narcotic-supplemented anaesthesia should be monitored by capnography and/or pulse oximetry in the early postoperative period.- - - - - - - - - - ranking = 7keywords = anaesthesia (Clic here for more details about this article) |
7/9. Clinical presentation of "silent" meningiomas after general anaesthesia.We present two patients who became unrousable within 48h after general anaesthesia for non-neurosurgical operations; both were found to have frontal meningiomas. Analysis of these and previous reports suggest that several anaesthetic and perioperative factors probably combine to contribute to the accelerated presentation of these previously "silent" tumours, and we recommend that dexamethasone should be administered early in the course of unexplained neurological deterioration after operation.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
8/9. Thyroid storm as a cause of loss of consciousness following anaesthesia for emergency caesarean section.A previously undiagnosed thyrotoxic patient was anaesthetised for an emergency Caesarean section. The recovery period was complicated by an acute thyroid crisis resulting in loss of consciousness following an apparently normal recovery from general anaesthesia.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
9/9. Coordinated expression in chronically unconscious persons.The clinically described 'persistent vegetative state' (PVS), consists of wakefulness unaccompanied by any evidence of the subject's awareness of self or environment. Past studies from our own and other laboratories have used positron emission tomography (PET) to study brain metabolism in approximately 20 such patients during wakeful periods. All those efforts identified global cerebral glucose metabolism at or below levels encountered during deep barbiturate anaesthesia. Nevertheless, the clinical literature includes rare reports of relatively isolated cognitive functions expressed by PVS patients late in their course. The observation raises the question of whether such activity reflects awareness or unconscious automatic behaviour. We employed magnetometry (MEG), PET scanning, MR imaging and 24-hour EEG recordings to evaluate three patients clinically vegetative between six months and 20 years after onset. Neither meticulous clinical examinations nor 24-hour EEG and video monitoring provided any hint of cognitive interaction in any subject. Nevertheless, patient 1 uttered single words once every 48 hours or more; patient 2 frequently expressed coordinated, non-purposeful, non-dystonic movements in arms and/or legs; and, patient 3 expressed strong emotional negativity without motor responses to noxious stimuli with occasional quieting in response to prosodic stimuli. All patients had whole-brain averaged global metabolism levels below 50% of normal. Patient 1, however, demonstrated preserved islands of increased metabolism in the posterior frontal and posterior temporal lobes, as well as MEG activations of Heschl's gyrus all located in the left hemisphere. In patient 2, selected increased metabolism was confined to the frontal poles and related subcortical structures. MRI in patient 3 demonstrated severe, bilateral post-traumatic cerebral atrophy. PET metabolism was diffusely reduced to 40% of normal but MEG evoked potentials indicated early and late sensory processing with abnormal later evoked components. The correlation of fragmentary behaviour with preserved metabolic and physiologic activity in cortical and subcortical regions known to support specific modular functions is novel. The finding demonstrates the capacity of severely damaged brains to partially express surviving modular functions without evidence of integrative processes that would be necessary to produce consciousness. We conclude that the mere expression of isolated neuropsychologic activity by isolated modules is insufficient to generate consciousness in overwhelmingly damaged brains.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |