RESUMO
The Fastrach laryngeal mask for intubation is a new device designed for blind orotracheal intubation in patients with criteria predictive of difficult airway control. The new device looks like the conventional laryngeal mask but offers a series of design changes that allow orotracheal intubation to be accomplished without visualization of the glottis. The rigid metal tube is bent and incorporates a metal handle; the two fixed bars that prevent the epiglottis from falling and blocking the opening have been replaced by a moveable bar that rises with the passage of the endotracheal tube and the exit of the V-shaped metal tube guides the endotracheal tube that was specially designed for this use. We describe three patients with cervical disease, one with advanced ankylosing spondylitis, one with traumatic luxation of the C6-C7 articulation and one diagnosed of two cervical disk hernias. All their tracheas were intubated without difficulty through the Fastrach mask with the patients' heads in neutral position. Although fiberoptic bronchoscopy is the method of choice in patients with cervical problems, the non-availability of the technique and the need for training in its use make the Fastrach mask an alternative worth considering for such patients.
Assuntos
Vértebras Cervicais , Deslocamento do Disco Intervertebral , Luxações Articulares , Máscaras Laríngeas , Idoso , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Espondilite AnquilosanteRESUMO
A 61-year-old woman in chronic treatment with 25 mg of amitriptyline underwent ovarian cancer resection under combined general and epidural lumbar anesthesia. After administration of local anesthetic she presented signs of severe arterial hypotension that was refractory to high doses of ephedrine and administration of dopamine alpha-adrenergic substances. Control was achieved with 200 micrograms of noradrenaline. We review the anesthetic implications of chronic use of tricyclic antidepressives as they affect choice of vasopressin for treating hypotensive events during anesthesia.
Assuntos
Amitriptilina/efeitos adversos , Anestesia Epidural/efeitos adversos , Anestésicos Combinados/efeitos adversos , Anestésicos Locais/efeitos adversos , Antidepressivos Tricíclicos/efeitos adversos , Bloqueio Nervoso Autônomo/efeitos adversos , Hipotensão/induzido quimicamente , Inibidores da Captação Adrenérgica/farmacologia , Amitriptilina/farmacologia , Anestesia Geral , Anestésicos Locais/farmacologia , Antidepressivos Tricíclicos/farmacologia , Inibidores da Captação de Dopamina/farmacologia , Sinergismo Farmacológico , Feminino , Humanos , Hipotensão/tratamento farmacológico , Pessoa de Meia-Idade , Norepinefrina/uso terapêutico , Neoplasias Ovarianas/cirurgiaAssuntos
Trifosfato de Adenosina/efeitos adversos , Neoplasias das Glândulas Suprarrenais/cirurgia , Anestesia Intravenosa , Anestésicos Intravenosos , Bradicardia/induzido quimicamente , Complicações Intraoperatórias/induzido quimicamente , Feocromocitoma/cirurgia , Propofol , Trifosfato de Adenosina/uso terapêutico , Adulto , Feminino , Humanos , Masculino , RiscoRESUMO
Subarachnoid block is a widely practiced anesthetic technique. With the availability of small-diameter needles and the rises in out-patient surgery, the number of procedures performed with subarachnoid block and short-term local anesthesia have increased. We report two cases of bilateral pain in the lower extremities appearing 20-24 h after intradural anesthesia with 2% hyperbaric lidocaine. We analyze the factors that might have triggered this complication and compare the two patients with 14 others described in the literature. Three points in common were found: the use of hyperbaric lidocaine, administration of the agent through small gauge needles and the performance of out-patient surgery.
Assuntos
Raquianestesia/efeitos adversos , Anestésicos Locais/efeitos adversos , Perna (Membro) , Lidocaína/efeitos adversos , Bloqueio Nervoso/efeitos adversos , Dor/etiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espaço SubaracnóideoRESUMO
We present the case of a 38-years-old tertipara at full term with a diagnosis by ultrasound of placenta previa who underwent elective cesarean under spinal anesthesia. After a difficult birth, anomalous adhesion of the placenta prevented its removal and caused massive hemorrhage of the placental bed and hypovolemic shock. Blood volume was restored and emergency hysterectomy under general anesthesia was effected, as bleeding and hemodynamic state were brought under control. Abnormal heart rhythm appearing after the operation responded to treatment; postoperative recovery was unremarkable. Placenta accreta is a rare complication of placenta previa. Given that massive obstetric hemorrhage is associated with significant mortality and morbidity, both maternal and fetal, the anesthesiologist must be aware of potential problems that might arise in cases of placental accreta so that readiness can keep risk to a minimum.