RESUMO
A 34-yr-old man with hepatic haemangiomatosis presented for orthotopic liver transplantation. His massively distended abdomen caused thoracic compression and severe restrictive lung disease. Respiratory failure was the principal indication for transplantation. Increased airway pressures, pulmonary hypertension, systemic hypotension caused by aorto-caval compression, and blood loss, complicated the intra-operative anaesthetic management. Weaning from mechanical ventilation was impaired by acute and chronic metabolic alkalosis, and diaphragmatic laxity.
Assuntos
Hemangioma/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Insuficiência Respiratória/etiologia , Adulto , Seguimentos , Hemangioma/complicações , Humanos , Neoplasias Hepáticas/complicações , MasculinoAssuntos
Anestésicos Inalatórios/efeitos adversos , Hidrocarboneto de Aril Hidroxilases , Autoanticorpos/sangue , Doença Hepática Induzida por Substâncias e Drogas/patologia , Sistema Enzimático do Citocromo P-450/imunologia , Isoflurano/efeitos adversos , Oxigenases de Função Mista/imunologia , Doença Hepática Induzida por Substâncias e Drogas/imunologia , Citocromo P-450 CYP2A6 , Ensaio de Imunoadsorção Enzimática , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Prophylactic epidural blood patch may prevent postdural puncture headache that develops after intentional or inadvertent dural puncture. However, despite earlier reports that this procedure was of value, subsequent studies have failed to show it has significant advantages over delayed blood patch. Reports that were supportive of this technique were based on nonrandomized observational studies with significant selective bias. At the present time, most centers do not routinely offer prophylactic blood patches, and those that do report a variable success rate. A recent case study of permanent neurologic deficit after prophylactic epidural blood patch has also raised some concern about the safety of this prophylactic technique.
Assuntos
Placa de Sangue Epidural , Cefaleia/prevenção & controle , Humanos , Resultado do TratamentoRESUMO
Minute ventilation-sensing pacemakers enable the paced heart to respond to an increased workload. Two patients with such a pacemaker developed pacemaker-driven tachycardia when connected to an electrocardiogram (ECG) monitor also capable of documenting ventilatory frequency and ECG lead disconnection. This tachycardia stopped when the ECG leads were removed. These pacemakers and monitors emit a low-amplitude electrical current and measure the resultant impedence signal across the chest. When patients are connected to the monitor the pacemaker sensor summates both impedence signals and the paced heart rate is increased as a result.
Assuntos
Marca-Passo Artificial/efeitos adversos , Pletismografia de Impedância/efeitos adversos , Taquicardia/etiologia , Idoso , Falha de Equipamento , Humanos , MasculinoRESUMO
The profound analgesic properties of intrathecal narcotics without motor blockade make them an excellent choice for pain relief during the first stage of labor. Recent studies have attempted to define more clearly the pharmacology of commonly used agents. In this review we shall outline some of these advances and discuss their impact on labor.
RESUMO
We describe two cases where we attempted to reduce the adverse effects of inadvertent spinal anaesthesia by aspirating local anaesthetic-contaminated cerebrospinal fluid (CSF). Analysis of this CSF for its local anaesthetic concentration revealed that we were able to recover 51% and 39% of the administered lignocaine. It is suggested that such aspiration may be a helpful additional measure to the supportive management of this complication.
Assuntos
Anestesia Epidural/efeitos adversos , Raquianestesia , Anestésicos Locais/líquido cefalorraquidiano , Lidocaína/líquido cefalorraquidiano , Adulto , Idoso , Anestesia Obstétrica/efeitos adversos , Cesárea , Feminino , Humanos , Gravidez , SucçãoRESUMO
We report a case of pneumocephalus following the attempted treatment of a postdural puncture headache by a continuous epidural saline infusion. Within 1 hour of infusion, symptoms of a severe headache, nausea, and vomiting prompted a computerized tomographic scan of the head that showed 12 to 15 ml of air in the cranium. The epidural space was located easily with the loss-of-resistance technique using 3 ml of air. A saline bolus and infusion were initiated after confirmation of correct placement of the epidural catheter. We suggest that air passed from the negative-pressure epidural space through the dural puncture created by the diagnostic spinal tap, producing a pneumocephalus.