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1.
BMC Anesthesiol ; 20(1): 80, 2020 04 07.
Article in English | MEDLINE | ID: mdl-32264827

ABSTRACT

BACKGROUND: Cerebral venous thrombosis can be a fatal complication of the postpartum period. Pregnancy is known to be a risk factor for thromboembolism in itself. CASE PRESENTATION: A normal spontaneous vaginal delivery was planned for a 20-year-old primigravida patient with patient-controlled epidural analgesia. Next morning, the patient complained of an occipital headache. An epidural blood patch was performed for diagnostic and therapeutic purpose with 10 ml of autologous blood. That night, she had an episode of seizures. Endotracheal intubation was done to secure the airway. She was transferred to an intensive care unit. Brain CT angiography and MRI showed superior sagittal sinus thrombosis with acute infarct and mild subarachnoid haemorrhage. For cerebral venous thrombosis treatment, heparin was injected and for intracranial pressure control, a hypertonic solution was injected. Despite this medical treatment, intracranial pressure continued to rise. The next day, her mental state changed to stupor. Emergency decompressive craniectomy was performed. Her mental state improved rapidly after surgery. A week later, she was transferred to a general ward. Her health recovered and she was discharged. CONCLUSIONS: We experienced postpartum cerebral venous thrombosis misdiagnosed as postdural puncture headache. We hope that this case report would be helpful in situation which a postpartum young woman complains severe headache in spite of management for headache including autologous epidural blood patch.


Subject(s)
Intracranial Thrombosis/diagnosis , Post-Dural Puncture Headache/diagnosis , Venous Thrombosis/diagnosis , Decompressive Craniectomy/methods , Diagnostic Errors , Female , Humans , Intracranial Thrombosis/surgery , Postpartum Period , Pregnancy , Pregnancy Complications/diagnosis , Venous Thrombosis/surgery , Young Adult
3.
Can J Anaesth ; 64(12): 1176-1181, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28952139

ABSTRACT

PURPOSE: The GlideScope® video laryngoscope (GVL) is widely used for nasotracheal intubation in dental and facial plastic surgery. The angle of the Magill forceps is different from that of the GVL blade, which suggests that the Magill forceps are not the ideal forceps for use with the GVL. The purpose of this study was to compare the effectiveness of the Magill forceps vs vascular forceps for nasotracheal intubation using the GVL. METHODS: This study included 60 patients scheduled to undergo elective surgery requiring nasotracheal intubation. Patients were assigned to one of two groups-i.e., Magill forceps (group M) or vascular forceps along with a tube exchanger (group V), by computer randomization. The primary outcome was total intubation time, defined as the time from when the anesthesiologist picked up the device to the time when three successive end-tidal CO2 waves were obtained following intubation. Secondary outcomes were blood in the endotracheal tube and trauma to the oral tissues or teeth. A blind observer assessed the presence of sore throat one hour and 24 hr after surgery. RESULTS: The total intubation time was significantly different between group M and group V (96.1 sec and 78.1 sec, respectively; mean difference, 18 sec; 95% confidence interval (CI), 13.7 to 49.7). The incidence of epistaxis in group M was significantly greater than that in group V (46.7% vs 16.7%, respectively; relative risk, 2.8; 95% CI, 1.2 to 6.8). CONCLUSION: The total intubation time was significantly less with the vascular forceps (and tube exchanger) than with the Magill forceps. Using vascular forceps also reduced the incidence of epistaxis compared with that using the Magill forceps. Using a tube exchanger and vascular forceps offers advantages over use of Magill forceps when a GlideScope video laryngoscope is used for nasotracheal intubation. TRIAL REGISTRATION: http://www.who.int/ictrp/network/cris2/en/ , CRIS, KCT0001310. Registered 29 July 2014.


Subject(s)
Intubation, Intratracheal/methods , Laryngoscopes , Laryngoscopy/methods , Adolescent , Adult , Aged , Carbon Dioxide/analysis , Elective Surgical Procedures/instrumentation , Elective Surgical Procedures/methods , Epistaxis/epidemiology , Equipment Design , Female , Humans , Intubation, Intratracheal/instrumentation , Laryngoscopy/instrumentation , Male , Middle Aged , Pharyngitis/epidemiology , Surgical Instruments , Time Factors , Video Recording , Young Adult
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