Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2010
Dapsone-associated methaemoglobinaemia in patients with a haematologic malignancy.
Methaemoglobinaemia is an uncommon problem which can significantly impact on oxygen carriage and may necessitate intensive care management. The occurrence of symptomatic methaemoglobinaemia over a three-month period in four patients with haematological malignancies on dapsone for Pneumocystis jiroveci pneumonia prophylaxis prompted a review of its use in this group of patients. We performed a retrospective audit to identify any contributing factors. ⋯ Our experience suggests that dapsone should be used with caution in patients with haematological malignancies as they are particularly at risk of developing symptomatic methaemoglobinaemia due to underlying anaemia, immunosuppression and potential drug interactions. The current recommendation of dapsone for Pneumocystis jiroveci pneumonia prophylaxis in this group of patients needs to be reviewed. When methaemoglobinaemia does occur early recognition is possible with routine co-oximetry testing and prompt treatment may lessen the need for or duration of intensive care supports.
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Anaesth Intensive Care · Nov 2010
Loss of resistance to saline reduces responses accompanying spinal needle insertion during institution of 'needle-through-needle' combined spinal-epidural analgesia.
Normal saline or air is used to identify loss of resistance during identification of the epidural space for combined spinal-epidural analgesia. Following epidural needle placement using air for loss of resistance, up to 80% of parturients move, grimace, vocalise or experience paraesthesia or dysaesthesia during subsequent dural puncture by a spinal needle. We compared the effects of saline versus air for loss of resistance on the occurrence of these subjective and objective responses during thecal penetration. ⋯ In those given saline and air respectively, 5 (18%) and 12 (44%) parturients responded to and/or acknowledged having perceived dural puncture (P < 0.005). Overall, 7 and 31 (P < 0.0005) subjective and objective responses occurred during dural puncture in those given saline and air, respectively. The study found that use of saline to determine loss of resistance is associated with fewer patient responses at the moment of thecal penetration during 'needle-through-needle' placement of the spinal needle at combined spinal-epidural analgesia.
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Anaesth Intensive Care · Nov 2010
Letter Case ReportsOral foreign body from defective laryngoscope blade.