Dengue haemorrhagic fever complicated by eclampsia in pregnancy.

A 28-year-old primigravida presented at 36 weeks of gestation with a one-week history of fever with myalgia. Diagnosis of dengue fever was made based on viral polymerase chain reaction. She progressed to dengue shock syndrome by day nine and subsequently recovered. She delivered a healthy male baby by the vaginal route, but within 24 hours of delivery, had an eclamptic seizure, which was controlled with intravenous magnesium sulphate. Mother and the baby were well at discharge and on the follow-up visit at three months.

Severe pulmonary hypertension in a patient with bronchiectasis complicated by cor pulmonale and a right-to-left shunt presenting for surgery.

A patient with advanced bronchiectasis, severe pulmonary hypertension complicated by cor pulmonale and a right-to-left shunt at atrial level presented for sigmoid colectomy. We outline the potential perioperative problems of this situation, discuss the perioperative risks and describe our clinical approach. A total intravenous anaesthetic technique using midazolam, fentanyl, ketamine and rocuronium was used to minimize changes in pulmonary and systemic vascular resistance and not induce bronchospasm. Preoperative nebulized salbutamol and ipratroprium were given to prevent bronchospasm and adrenaline and noradrenaline were infused to maintain cardiac output and the balance between systemic and pulmonary vascular resistance.

Dose response study of lidocaine 1% for spinal anaesthesia for lower limb and perineal surgery.

PURPOSE: To compare the sensory and motor block produced by three different volumes of intrathecal lidocaine 1% and thereby determine the appropriate volume to administer for surgery of the lower limbs and perineum. METHODS: Forty-eight patients scheduled for perineal or lower limb surgery were randomly assigned to receive 4, 6 or 8 ml lidocaine 1% intrathecally. The onset, spread, duration and regression of analgesia and motor block and side effects were evaluated (by a blinded observer whenever possible). RESULTS: The maximum cephalad spread in the 6 ml (T8 +/- 3) and 8 ml (T4 +/- 1.7) groups were higher than the 4 ml group (T12 +/- 2.2, P < 0.01). In the 4 ml group, six patients (33%) did not achieve analgesia to T12 and four (22%) did not have complete motor blockade. Patients given 8 ml had longer duration of block (duration at T12: 104 +/- 23 vs 60 +/- 24, 67 +/- 14 min. P < 0.01: 8 ml vs 4, 6 ml) and slower recovery times (sensory recovery: 188 +/- 27 vs 142 +/- 27, 157 +/- 28 min. P < 0.01; 8 ml vs 4, 6 ml). Two patients (18%) from the 8 ml group and one (5%) from the 6 ml group had transient hypotension. CONCLUSION: Four millilitres intrathecal lidocaine 1% is adequate for perineal surgery but for lower limb procedures, 6 ml is more appropriate as it consistently provides sensory analgesia above L1 dermatome and complete motor block. Eight ml gives an unnecessarily high block with higher incidence of hypotension.