1/129. Management of exsanguinating hemoptysis during cardiopulmonary bypass.BACKGROUND: Large-volume hemoptysis during cardiopulmonary bypass is an infrequent, but life-threatening event. Rapid airway clearance and control are the primary prerequisites for successful management. methods: The cases of 3 patients with different sources of exsanguinating hemoptysis during cardiopulmonary bypass managed initially with rigid bronchoscopy were reviewed. RESULTS: In all patients, airway control was rapidly established and weaning from cardiopulmonary bypass CPB was accomplished. Two patients survived the operative procedure. The other patient died in the operating room of unremitting bilateral pulmonary hemorrhage. CONCLUSIONS: Major hemoptysis during cardiopulmonary bypass is best dealt with initially by rapid airway control and cessation of bypass in an expeditious manner. An algorithm for suggested management is provided. The rigid bronchoscope is the optimal tool for initial management and it should always be available. Definitive treatment is determined by the cause and the persistence of hemorrhage once these maneuvers have been performed.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/129. Life-threatening haemorrhage following obturator artery injury during transurethral bladder surgery: a sequel of an unsuccessful obturator nerve block.In spite of prior blockade of the obturator nerve with 1% mepivacaine (8 ml) utilizing a nerve stimulator, violent leg jerking was evoked during transurethral electroresection of a bladder tumour approximately 1 h after the blockade in a 68-year-old man. The patient became severely hypotensive immediately following the jerking, and a large lower abdominal swelling concurrently developed. The urgent laparotomy indicated that the left obturator artery was severely injured by the resectoscope associated with the bladder perforation, causing acute massive haemorrhage. The patient recovered uneventfully after adequate surgery. Investigation of the literature suggested that both our nerve stimulation technique and anatomical approach were appropriate. It was therefore unlikely that our block resulted in failure because of an inappropriate site for deposition of the anaesthetic. However, consensus does not appear to have been obtained as to the concentration and volume of the anaesthetic necessary for prevention of the obturator nerve stimulation during the transurethral procedures. The concentration and volume of mepivacaine we used might have been too low and/or small, respectively, to profoundly block all the motor neuron fibres of the nerve. Alternatively, stimulation of the obturator nerve might occur because of the presence of some anatomical variant, such as the accessory obturator nerve or its abnormal branching. In conclusion, some uncertainty appears to exist in the effectiveness of the local anaesthetic blockade of the obturator nerve. In order to attain profound blockade of the motor neuron fibres of the obturator nerve and thereby prevent the thigh-adductor muscle contraction which can lead to life-threatening situations, we recommend, even with a nerve stimulator, to use a larger volume of a higher concentration of local anaesthetic with a longer duration in the obturator nerve block for the transurethral procedures.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
3/129. Severe aspiration pneumonia after surgery for reconstructed gastric tube cancer treated with extracorporeal life support.A 68-year-old man who had received resection for thoracic esophageal cancer 8 years ago, was operated on for the cancer of the reconstructed gastric tube. On the day of the operation, he accidentally swallowed gastric juice due to an obstruction in the reconstructed gastric tube. He suffered from acute hypoxic respiratory failure which could not be controlled with conventional therapy on postoperative day 1. Therefore, extracorporeal life support was employed at 3.0 L/min. extracorporeal flow for 11 days. Before extracorporeal life support data: PO2/FiO2 = 45, A-aDO2 = 600. During extracorporeal life support, the ventilator setting was pressure control (16 cmH2O) ventilation with a positive end expiratory pressure of 8 cmH2O, respiratory rate of 5 breaths/min., and FiO2 of 0.4. The patient was successfully weaned from extracorporeal life support and extubated on postoperative day 12. After extracorporeal life support data: PO2/FiO2 = 225, A-aDO2 = 465. We report on a successful weaning case from extracorporeal life support and discuss the efficacy these of regarding this patient.- - - - - - - - - - ranking = 10keywords = life (Clic here for more details about this article) |
4/129. Complications of retrograde balloon cautery endopyelotomy.PURPOSE: adult ureteropelvic junction obstruction is increasingly managed with endoscopic techniques. Retrograde balloon cautery endopyelotomy is quick, requires minimal hospital stay and allows most patients a rapid return to work. The complication rate of retrograde balloon cautery endopyelotomy ranges from 13 to 34%, with vascular injury in 0 to 16% of patients. We report 5 uncommon complications, including 4 vascular injuries, that clinicians should be familiar with when using this technique. MATERIALS AND methods: We reviewed 52 retrograde endoscopic endopyelotomy procedures performed during a 5-year period. There were 5 uncommon complications. RESULTS: Accessory lower pole renal artery injuries occurred in 3 patients, 1 of whom presented 12 days after endopyelotomy. Embolization was successfully performed in all 3 cases and none had subsequent hypertension. In 1 case a right ovarian vein laceration was not evident on preoperative or postoperative angiography. Emergency post-embolization abdominal exploration revealed a 2 mm. injury to the right ovarian vein before entering the right renal vein close to the ureteropelvic junction incision. nephrectomy and ovarian vein ligature were curative. In 1 case the electrocautery wire broke intracorporeally after firing, resulting in a bobby pin-like configuration. Successful removal was accomplished by twisting the catheter and wrapping the wire around the tip, enabling atraumatic removal. CONCLUSIONS: Retrograde balloon cautery endopyelotomy is an emerging technology with potential adverse outcomes. The complications we noted are complex and potentially life threatening. awareness of these complications may help avoid poor outcomes and expedite appropriate treatment.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
5/129. Aortopulmonary collateral artery embolization during postoperative extracorporeal membrane oxygenation after arterial switch procedure.Aortopulmonary collateral arteries sometimes complicate cyanotic congenital heart defects. Combined with a relevant left-right shunt, this could result in massive airway bleeding during and after corrective surgery. A preoperatively diagnosed 1.2 mm small aortopulmonary collateral artery in a newborn suffering from transposition of the great arteries caused life-threatening airway bleeding during surgery. Postoperative extracorporeal membrane oxygenation (ECMO) was necessary, and coil embolization was performed on ECMO to terminate pulmonary bleeding.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
6/129. Ultrasonographic assessment of the risk of injury to branches of the middle hepatic vein during laparoscopic cholecystectomy.BACKGROUND: Although hemorrhage from the gallbladder bed during laparoscopic cholecystectomy is one of main reasons for conversion to open cholecystectomy, the cause of this life-threatening complication is unclear. patients AND methods: color Doppler ultrasound was used to examine the cause of venous hemorrhage from the gallbladder bed during laparoscopic cholecystectomy in 4 patients postoperatively and to examine the anatomic relationship between the gallbladder bed and branches of the middle hepatic vein in 50 healthy volunteers. RESULTS: Injury to a large branch of the middle hepatic vein adjacent to the gallbladder bed was diagnosed in all 4 patients. One patient required conversion to open cholecystectomy while the bleeding in 2 patients was immediately controlled by direct pressure with the gallbladder. The branch of the middle hepatic vein was completely adherent to the gallbladder bed in 5 of the 50 volunteers, and in 1 the diameter of the branch was as large as 3.5 mm. In 3 volunteers branches 3.0 to 3.8 mm in diameter traversed as close as 1.0 mm from the gallbladder bed. CONCLUSIONS: patients with large branches of the middle hepatic vein close to the gallbladder bed are at risk of hemorrhage during laparoscopic cholecystectomy and should be identified preoperatively with ultrasound.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
7/129. epinephrine-induced potentially lethal arrhythmia during arthroscopic shoulder surgery: a case report.Arthroscopic shoulder surgery performed on a healthy female could have resulted in a fatal outcome when the epinephrine present in the arthroscopic irrigating solution contributed to the onset of ventricular tachycardia requiring defibrillation during surgery. During this procedure, the shoulder was infiltrated with 30 mL of a 1:100,000 solution of epinephrine into the subacromial space and glenhumeral joint. Subsequently, instrumentation of the glenhumeral joint by the orthopedic surgeon with a standard arthroscopy trocar resulted in a 0.5-cm size lesion to the posterior humeral cortex. Minutes after the start of the surgical procedure, the patient displayed an abrupt onset of ventricular tachycardia and hypertension. These signs and symptoms suggested an intraosseous infusion of both infiltrated and irrigation solution containing epinephrine through the lesion in the humeral cortex. Approximately 800 mL of a .01 mg/mL concentration of irrigation solution containing epinephrine was used. A diagnosis of epinephrine-induced ventricular tachycardia was made. The arthroscopic irrigating solution was immediately discontinued and lidocaine, 100 mg intravenously, was administered; however, the patient's cardiac rhythm degenerated into a sustained ventricular tachycardia that was unresponsive to pharmacologic intervention. A full code was called; the surgeon, anesthesia team, and operating room personnel succesfully provided advanced cardiac life support and cardioverted the patient back into a sinus rhythm with no untoward effects.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
8/129. Hypermagnesemia in a pediatric patient.Implications: A high blood magnesium level is a rare but life-threatening event. This case report describes an accidental overdose of magnesium that occurred in an 18-month-old girl during a routine operation. The effects of high magnesium levels and its treatment are explained in detail.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
9/129. Anomalous origin of the left coronary artery: discovery during an ambulatory surgical procedure in a 3-month old, previously healthy infant.We report a rare coronary anomaly in a 3-month old symptomless infant with an anomalous origin of the left coronary artery, that became manifest during anaesthesia for an ambulatory procedure, leading to circulatory arrest. Precordial stethoscope and pulse oximeter unequivocally showed a circulatory arrest. Even in ambulatory procedures, a presumed healthy patient may quickly develop a life-threatening condition because of occult disease. The successful management of such cases depends on efficient and coordinated teamwork.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
10/129. Tension pneumothorax as a complication of video-assisted thorascopic surgery for anterior correction of idiopathic scoliosis in an adolescent female.STUDY DESIGN: This case report illustrates the occurrence of intraoperative tension pneumothorax, a previously unreported complication occurring during anterior instrumentation for correction of scoliosis by video-assisted surgery. OBJECTIVES: To demonstrate a consequence of overadvancement of a Steinmann pin (guide wire). SUMMARY OF BACKGROUND DATA: Although intraoperative tension pneumothorax is admitted to be a theoretical complication of video-assisted surgery for anterior correction of idiopathic scoliosis, there has yet to be a case reported in the literature. This report presents the first case of this complication. methods: A 13-year-old girl who had right thoracic scoliosis with a curve measuring 54 degrees underwent video-assisted surgery discectomy and anterior spinal fusion with instrumentation of T5 through T11. Single-lung ventilation had been achieved with a double-lumen tube and the right lung was deflated. After approximately 4.5 hours of complication-free surgery, intraoperative fluoroscopy showed an approximately 2-cm overadvancement of a guide wire into the opposite hemithorax. Approximately 5 minutes after the overadvancement was corrected, the patient experienced a gradual increase in heart rate and a corresponding gradual decrease in oxygen saturation and both systolic and diastolic blood pressures. Approximately 35 minutes later, it was determined that the patient had sustained a tension pneumothorax of the left hemithorax. RESULTS: The patient underwent urgent partial reinflation of the right lung and a tube thoracostomy of the left thoracic cavity. vital signs quickly returned to stable levels, and the left lung easily reinflated with the chest tube suction. The patient remained stable after the procedure was resumed (by right lung deflation). The remainder of the surgery and the postoperative course were uneventful. CONCLUSIONS: Although video-assisted surgery continues to gain popularity in the management of spinal deformities, the surgical team must be certain to pay meticulous attention to detail throughout the procedure. The early detection and treatment of complications can be life-preserving.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
| | Next -> |