Tracheal perforation following double-lumen intubation: a case report.

Tracheal perforation following endotracheal intubation is an underestimated complication that seriously compromises prognosis. Treatment can be either conservative or surgical, depending on the lesion and the patient's clinical condition. In this case report, we describe a patient in whom tracheal perforation occurred during double-lumen tube placement for elective surgery on a pulmonary nodule. As the perforation was accessible to the surgeon, a running suture could be made from the oesophageal wall.

Connection error in the delivery of medical gases to a surgical unit.

Whilst anesthetic incidents due to problems with the delivery of medical gases to a surgical unit are exceptional, their consequences are potentially drastic. With the growing of modern hospitals, every anesthetist may one day find himself confronted with such events, which are new to him, partly because they are infrequent, but mainly because they are due to causes outside his immediate environment. A simple mistake in the labelling and identification of medical gas lines resulted in a cross-connection of the oxygen and air, causing perioperative hypoxemia following the administration of a mixture poor in oxygen. The questions of training, responsibility and procedures in regard to these types of incidents are discussed below.

[Non-traumatic method of intubation of the lacrimal duct using a silicone tube: synergism between the ophthalmologist and the anesthetist]. / Méthode atraumatique d'intubation de la voie lacrymale par tube de silicone: synergie entre l'ophtalmologue et l'anesthésiste.

The authors evaluate an atraumatic catheterisation of the lacrymal system by using a prolene silastic intubation and a standard nasal aspiration probe. After recovery of both prolene end and nasal probe out of the throat the prolene was threaded into the aspiration probe and both were taken off back out of the nose.

Acute corticosteroid myopathy in intensive care patients.

Several recent studies have attributed the occurrence of acute myopathy in intensive care unit patients to the combination of corticosteroids and neuromuscular junction blocking agents (NMBAs) used for mechanical ventilation. We present 4 patients who developed acute myopathy after administration of high doses of glucocorticoids during sedation with propofol without any NMBAs. All patients had elevated creatine kinase levels. Electrophysiological studies indicated normal motor and sensory nerve conduction velocities but reduced motor nerve response amplitudes. Needle electromyography identified abnormal spontaneous activity; motor unit potentials were polyphasic of low amplitude and short duration, characteristic of a myopathic process. Muscle biopsy demonstrated a prominent acute necrotizing myopathy in all 4 patients with a loss of thick filaments. Our observations support glucocorticoids rather than NMBAs as the main offending drug in acute corticosteroid myopathy. The predisposing factor should be the hypersensitivity of paralyzed muscles to corticosteroids regardless of the drug inducing paralysis: NMBAs or propofol.

Haemothorax after attempted intercostal catheterisation.

A 30-year-old man with chronic abdominal pain was referred to the Pain Relief Unit after a course of unsuccessful diagnostic blocks and treatments. On admission, history, examination and clinical investigations were consistent with a large pleural effusion due to a recent attempt to catheterise the intercostal space. Pleural drainage confirmed the diagnosis of haemothorax. Percutaneous intercostal nerve blocks are usually considered as safe and simple and no-one to our knowledge has reported such a complication.

MRI and clinical study of an easy and safe technique of suprascapular nerve blockade.

Suprascapular nerve block is used with increasing frequency by anaesthetists and rheumatologists in the management of shoulder pain from a variety of disorders. In the classical technique, the needle is introduced into the supraspinous fossa perpendicular to the blade of the scapula and then is moved to enter the scapular notch, with the risk of pneumothorax or damage to the suprascapular nerve or vessels. However, it is not necessary to locate the scapular notch in order to perform this block. Introducing the needle parallel to the blade, i.e. away from the direction of the lung and the suprascapular nerve and vessels, and injecting the solution into the floor of the supraspinous fossa is an easy and safe technique. We report the results of a MRI and clinical study that confirm the efficacy of this approach.

Adding clonidine to mepivacaine prolongs the duration of anesthesia and analgesia after axillary brachial plexus block.

BACKGROUND AND OBJECTIVES: This study evaluates the effects of clonidine added to mepivacaine on the duration of anesthesia and analgesia after axillary brachial plexus block. METHODS: Thirty patients scheduled for elective hand surgery were divided into three equal groups in a randomized, double-blinded fashion. An axillary perivascular brachial plexus block was performed with 40 ml 1% mepivacaine plus 1:200,000 epinephrine in the three groups. Group B also received 150 micrograms clonidine subcutaneously and Group C had the same dose of clonidine mixed with the local anesthetic and injected into the plexus sheath. The following variables were recorded: onset time, duration of anesthesia, duration of analgesia, postoperative pain score, intake of analgesics, and adverse effects. RESULTS: The three groups were comparable in terms of age, sex, weight, height, onset time of anesthesia, postoperative pain score, and analgesic requirement. The duration of anesthesia and analgesia was comparable in Groups A and B, but both variables were significantly increased in Group C: the duration of anesthesia and analgesia were prolonged, respectively, by 37 +/- 6% and 103 +/- 16% when compared to Group A and by 32 +/- 7% and 89 +/- 15% when compared to Group B. No side effects were reported. CONCLUSIONS: One hundred fifty micrograms clonidine added to mepivacaine for brachial plexus block prolongs the duration of anesthesia and analgesia. Our results suggest that this effect of clonidine is local rather than systemic.