Anaesthesia and intensive care
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We describe a case of tracheal rupture diagnosed after an apparently routine endotracheal intubation for otherwise uneventful lower abdominal surgery in a 33-year-old woman. Risk factors for tracheal rupture, presenting symptoms and signs, management of tracheal rupture and methods of airway management during the surgical repair of the tracheal laceration are discussed. In this case, "side-by-side" microlaryngoscopy tubes, one endobronchial and the other with the tip in the upper trachea, placed with fibreoptic assistance were used for airway management during the tracheal repair.
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Anaesth Intensive Care · Oct 2003
Case ReportsOrthodeoxia--an uncommon presentation following bilateral thoracic sympathectomy.
We present a case of orthodeoxia (postural hypoxaemia) which resulted from a combination of lung collapse/consolidation and blunted hypoxic pulmonary vasoconstriction due to partial interruption of the sympathetic nerve supply to the lung by bilateral thoracic sympathectomy.
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Anaesth Intensive Care · Oct 2003
Case ReportsTerlipressin infusion in catecholamine-resistant shock.
Catecholamine-resistant shock is not uncommon in intensive care. Bolus dose terlipressin (a vasopressin analogue) has been used successfully in this setting allowing cessation of other vasopressor agents. ⋯ We describe a case report where the use of a continuous terlipressin infusion was associated with a dramatic improvement. To our knowledge there have been no previous reports of the use of terlipressin by continuous infusion for the treatment of catecholamine-resistant shock.
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Anaesth Intensive Care · Oct 2003
Case ReportsFailed extubation of a double-lumen tube requiring a cricoid split.
Following a five-hour procedure, it was not possible to remove a double-lumen endobronchial tube that had been placed to facilitate the removal of a massive spleen from a 45-year-old female. The tube had been passed easily at the start of surgery, but was firmly stuck at the level of the cricoid at the end of surgery. Surgical removal of the tube by a cricoid split was required 48 hours later. Consideration of previous airway manipulations, careful choice of airway devices and regular checks of airway patency around tracheal tubes during lengthy procedures may prevent similar events in the future.