Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Jul 2014
Case ReportsSymptoms of hypovolemic shock during the induction of general anaesthesia in a patient with large vascular malformation--an adverse effect of propofol and sevoflurane?
Venous malformations are the second most common congenital vessel anomaly. In our hospital, we conduct up to 30 sclerotherapies with 1-3% aethoxysclerol annually in children of all ages. The procedure is invasive and painful and therefore requires general anaesthesia. ⋯ Volatile anaesthetics and propofol decrease the systemic vascular resistance and cause vasodilatation. Our patient presented with hypotonic shock due to the redistribution of blood to the dilated venous malformation, which developed after the use of standard concentration of sevoflurane. Intravenous anaesthetics were administered during induction and might have increased that effect. Although we found no similar reports, we believe that patients with vast venous malformations can experience such complications after the use of volatile anaesthetics, especially in high concentrations.
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Anaesthesiol Intensive Ther · Jul 2014
Radiofrequency neurotomy for the treatment of chronic pain: interference with implantable medical devices.
Radiofrequency is widely used in the treatment of chronic pain for its efficacy and low incidence of side effects and complications. Despite this, it is commonly believed that this kind of treatment could interfere with medical implantable devices. Potential interference between implanted devices such as pacemakers, defibrillators and spinal cord stimulators and the radiofrequency of neurotomy is an important concern for physicians caring for patients with these devices. ⋯ There are several theoretical concerns about radiofrequency treatments in patients with implantable electrical medical devices. However, there is no experimental evidence of electrical interference with the implanted devices. Our long experience strongly suggests that by following simple precautions, patients can benefit from radiofrequency pain-relieving procedures without any adverse events.
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The objective of this study was to review all published articles in the English language literature about the coagulation management of epidural corticosteroid injections (ESI) in humans. ESI are among the most commonly used procedures to manage chronic spinal pain, yet there is no conclusive review on the coagulation management of this popular procedure. ⋯ Reports were also located through references of articles. We conclude that even though epidural steroid injection is one of the most used techniques in treating radicular pain, correct management of coagulation is necessary.