Journal of anesthesia
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Journal of anesthesia · Feb 2012
Case ReportsSevere post-burn neck contracture release and skin graft harvest using tumescent local anaesthesia as the sole anesthetic technique.
Severe post-burn contractures in the neck often cause anatomical distortion and restriction of neck movements, resulting in varying degrees of difficulty in airway management. Any mode of anesthesia that may obviate the need for imperative airway control may be desirable in such situations in which a difficult airway may be anticipated. ⋯ The other benefits of this method were minimal blood loss and excellent postoperative analgesia. In conclusion, it can be emphasized that the application of tumescent anesthesia is an important anesthetic tool in patients with predicted difficult airway management.
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Journal of anesthesia · Feb 2012
High mortality associated with intracardiac and intrapulmonary thromboses after cardiopulmonary bypass.
Intrapulmonary or intracardiac thrombosis is a rare but catastrophic event following complex cardiothoracic surgery. Although there have been multiple cases reported in the literature, the causes of these events are largely unknown. In this retrospective review, we attempt to identify risk factors and propose possible mechanisms of thromboses after cardiopulmonary bypass (CPB). ⋯ Massive thrombosis following cardiac surgery is a highly lethal event with limited treatment options. Particular attention should be paid to the status of thrombin regulatory proteins before protamine and other hemostatic interventions in patients undergoing complex cardiac surgery with antifibrinolytic agents.
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Journal of anesthesia · Feb 2012
Case ReportsSubclinical neuropathy in diabetic patients: a risk factor for bilateral lower limb neurological deficit following spinal anesthesia?
Total knee arthroplasty performed under spinal or general anesthesia is a common successful orthopedic procedure. Nonetheless, in patients with diabetes mellitus this procedure can present unique challenges to orthopedic surgeon and anesthesiologist alike. We describe a case of an elderly male diabetic patient who developed bilaterally symmetrical lower limb neurological deficit following an uneventful total knee arthroplasty performed under spinal anesthesia. ⋯ These findings were consistent with a preexisting neuropathy, thereby suggesting a subclinical neuropathy as a potential risk factor for this neurological complication. Our case highlights the fact that patients with longstanding comorbidities, namely peripheral vascular disease and diabetes mellitus, may be at an increased risk of neurological injury following regional anesthesia. Hence, we believe that preoperative evaluation of diabetic patients should include neurophysiological studies to identify subclinical neuropathy and minimize the risk of neurological injury.
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Journal of anesthesia · Feb 2012
Case ReportsLarge mediastinal tumor in a neonate: an anesthetic challenge.
Mediastinal tumors pose a grave risk of cardiopulmonary complications during the perioperative course, particularly in neonates and small children. These tumors can cause displacement and compression of vital thoracic structures such as the tracheobronchial tree, the heart, and the great vessels. Catastrophic complications often occur during induction of anesthesia, use of muscle relaxants, positioning, and at the time of extubation. We present our experience of anesthetic management of a neonate with a mediastinal mass who had features of both airway and vascular obstruction.
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Journal of anesthesia · Feb 2012
Case ReportsFailure of supraclavicular block under ultrasound guidance: clinical relevance of anatomical variation of cervical vessels.
We describe a case with partial analgesia after ultrasound-guided supraclavicular block for elbow surgery. The failure of the block was caused by the limited spread of local anesthetic because of blockage by a vessel (either transverse cervical artery or dorsal scapular artery) running through the brachial plexus. Anesthesiologists should be aware that cervical anatomy is complex and has anatomical variations. Thus, careful ultrasound screening of anatomical structure, especially using color Doppler, is important in performing brachial plexus block.