Paediatric cardiomyopathy and anaesthesia.

'Cardiomyopathy' (CM) is defined by the World Health Organization as 'a disease of the myocardium associated with cardiac dysfunction'. In a child, it is associated with a significant risk for anaesthesia. In addition, cardiac arrest under anaesthesia has been attributed to an undiagnosed CM. Care of these patients is complicated by the fact that there are several different forms of CM that have differing anaesthesia management goals, aimed at maintaining the patient's baseline haemodynamic variables of preload, heart rate, contractility, and afterload. With the emergence of new diagnostic tools, together with advances in cardiac imaging and improved treatment modalities (such as ventricular assist devices), the anaesthetic management of a child with a CM is evolving. This review describes the different forms of the disease in terms of pathology, aetiology, and clinical presentation. Dilated, hypertrophic, and restrictive CM are the most common forms. We examine recent advances in therapy, including the management of severe end-stage disease, while highlighting the specific anaesthetic considerations for children with each type of CM.

Adult epiglottitis: an under-recognized, life-threatening condition.

Epiglottitis in the adult can be fatal and should be treated with the same degree of concern and suspicion in respect of airway patency as in children. We present three cases of adult epiglottitis in which the airway was lost prior to or during the intervention of an anaesthetist. We suggest that an emphasis on conservative management is distracting and belies the serious nature of this disease.

The effect of ionised magnesium on coagulation using thromboelastography.

Magnesium is an ionised mineral with therapeutic uses. There is laboratory evidence that it may have an anticoagulant activity although recent research has been to the contrary. The clinical implications of the effect of a therapeutic dose of magnesium on coagulation have yet to be resolved conclusively. In our study, 10 healthy volunteers were given 4 g of magnesium sulphate intravenously. Thromboelastographs were recorded and blood analysed for haematological indices, before and after the infusion. All variables associated with coagulation remained unchanged except the alpha angle on the thromboelastograph which increased significantly. We conclude that in our in vivo study, the effect of magnesium sulphate on coagulation is not clinically significant.

Local anaesthesia for laminectomy surgery.

Neurosurgical patients presenting for laminectomy surgery may have premorbid pathology that either contraindicates general anaesthesia or at least represents a significant risk to the patient. We present a sample case from a series of ten patients in whom laminectomy surgery was performed under local anaesthesia. The mean duration of surgery was 98 minutes and the average dose of lignocaine used was 1.91 mg/kg and, therefore, within safe limits. One patient was converted to a general anaesthetic. We believe that local anaesthesia can offer a safe and satisfactory alternative, in patients who may otherwise be denied surgery. The additional advantage of awake neuro-monitoring, may also reduce the risk of inadvertant spinal cord injury.