1/13. Dural puncture and corticotherapy as risks factors for cerebral venous sinus thrombosis.Dural puncture with corticosteroid could be a predisposing factor for cerebral venous thrombosis (CVT). A 35-year-old woman using oral contraception was treated with corticosteroid epidural infiltration for L5 radiculalgia. The following day a postural headache developed and accidental dural puncture was suspected. Four days later, she presented with fever and consciousness impairment requiring mechanical ventilation. magnetic resonance angiography (MRA) confirmed thrombosis of the superior sagittal sinus. Recanalization was observed three weeks later and the patient fully recovered. blood tests for thrombophilia showed a moderate decrease in the C protein level (chronometric activity 44%, N = 65-130). CVT has been reported after spinal anaesthesia or peridural anaesthesia with accidental puncture. After dural puncture the decrease of cerebrospinal fluid pressure induces a rostrocaudal sagging effect with traumatic damage to the fragile venous endothelial wall, and may trigger a venous vasodilatation with resultant stasis. CVT has also been described in patients after lumbar puncture and oral corticoid treatment for multiple sclerosis and after corticosteroid intrathecal infiltration. Therefore, corticosteroids can be considered as a potential additional procoagulant stimuli.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/13. Urethrorectal fistula by bull horn injury.Bull horn injuries are common in rural india. Here one such case causing urethrorectal fistula has been reported. The patient was presented with history of bull horn injury 6 hours back. He was examined under general anaesthesia and found to have lacerations in the anus and anterior wall of rectum. Urgent retrograde urethrography and cystography showed partial rupture of bulbar urethra and urethrorectal fistula. Initially sigmoid colostomy and suprapubic cystostomy was done. Later optical internal urethrotomy was done. The patient was catheterised for 3 weeks and the fistula healed completely.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
3/13. Intra-oral traumatic implantation: a case report.A case of traumatic implantation of a broken piece of a ball point pen in the pterygomandibular region in a 13-year-old male patient is presented. Removal of the pen shaft was done by blunt dissection and careful manipulation under local anaesthesia. The possible complications of similar cases are enumerated.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
4/13. Instrumental bronchial tears.Two case reports of bronchial tears following airway instrumentation are presented, one of which resulted in death. Both patients developed pneumothoraces and other complications after attempts had been made under general anaesthesia to insert bronchial stents. It appeared that bronchial tears were made during instrumentation with the stent introducer and these cases demonstrate that great care should be taken when rigid materials, such as plastic guides and bougies, are used blindly in the airway.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
5/13. External and internal rigid fixation.A 25-year-old labourer sustained submandibular and intra-oral injuries in an unusual industrial site accident. He fell from above onto steel reinforcing rods which were set in concrete and projecting two metres above the concrete floor. He was impaled by a rod which entered the mouth beneath the right side of the mandible and exited from the mouth passing upwards in front of the nose. The management of this patient is discussed with particular emphasis on the method of obtaining an airway for surgery. Due to the proximity of the rigidly embedded reinforcing rod to the nose, mouth and midline of the neck, an awake tracheostomy under local anaesthesia was conducted. The alternatives to this approach with their potential complications are discussed. In addition possible pre-, peri- and post-operative surgical complications for this case are outlined.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
6/13. Fatal and non-fatal stingray envenomation.A fatality occurred in a previously healthy 12-year-old boy after a penetrating chest injury from a stingray barb. The injury occurred under freak circumstances. death was a result of cardiac tamponade which was secondary to venom-induced, localized myocardial necrosis and spontaneous perforation, six days after the direct penetration of the right ventricle by the barb. Three other cases of less serious stingray envenomation are described which illustrate the significant localized morbidity that may occur without immediate wound exploration and toilet after adequate anaesthesia. We also report a study of a series of 100 minor stingray envenomations which, when treated, resulted in no morbidity. It is possible that local infiltration with 1% plain lignocaine may have a direct counteraction against stingray venom that remains in the wound area. Stingray venom has insidious, but powerful, localized tissue necrosing properties in humans.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
7/13. Penetrating wounds of the neck. Experience from a Swedish hospital.Stab wounds of the neck were retrospectively studied in 28 patients. neck stabbings constituted 9% of all stab wounds recorded during the same period. Vascular injuries were most frequent, and the mortality rate was 14%. The management of neck stab wounds is discussed and three cases are presented to illustrate the difficulties and pitfalls. It is proposed that all wounds penetrating the platysma should be explored in general anaesthesia.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
8/13. An impaled neck. Management of difficult airway access.We describe the management of a patient impaled through the lower submandibular area by the top spike of some iron railings which immobilised his jaw and blocked access to the trachea. The Fire Brigade used specialised equipment to cut out a section of the railings so that the patient could be transported to hospital. Awake fibreoptic intubation was used to gain access to the patient's airway before induction of anaesthesia.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
9/13. Tracheocele: a rare cause of difficult endotracheal intubation and subsequent pneumomediastinum.A case is described in which accidental perforation of a tracheocele caused by endotracheal intubation resulted in a postoperative pneumomediastinum. The tracheocele, an extremely rare finding in clinical anaesthesia, was confirmed radiologically and for the first time demonstrated by computed tomography.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
10/13. Infected false aneurysm after puncture of an aneurysm of the deep femoral artery.Pseudoaneurysm of the femoral artery is a well known complication after diagnostic and therapeutic catheterisation. We report a case of voluminous postcatheterisation false aneurysm, which developed on a pre-existing deep femoral artery aneurysm. infection by staphylococcus aureus was demonstrated. After surgical exploration, rupture and external haemorrhage occurred before reconstructive surgery was possible. Due to the septic conditions only a lateral aneurysmorraphy was performed. Postoperative angiogram showed an acceptable result. An aneurysm of the deep femoral artery was also demonstrated on the contralateral side. This was scheduled for elective surgery. In conclusion, this complication could have been avoided by accurate puncture technique. Surgical exploration under local anaesthesia is ill-advised. Especially in patients with advanced vascular disease, non-invasive studies of the puncture site is recommended.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
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