European journal of anaesthesiology
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Unilateral malignant hyperinflation of the lungs during positive pressure mechanical ventilation was described during aggressive respiratory therapy of unilateral lung disease or in situations of significant difference in compliance between the two lungs. We report a case of malignant hyperinflation of the nondependent lung during chest surgery. The differential diagnosis and treatment with differential lung ventilation are described.
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Clinical Trial
Quality of anaesthesia for insertion of tension-free vaginal tape using local analgesia and sedation.
The use of tension-free tape in the vagina is a relatively new surgical procedure for the treatment of urinary incontinence. Traditionally, the procedure is carried out using local anaesthesia and sedation. We aimed to assess the quality of anaesthesia obtained during insertion of tension-free vaginal tape using local anaesthetic infiltration and intravenous conscious sedation. ⋯ Satisfactory anaesthetic conditions can be achieved for the insertion of tension-free vaginal tape using local anaesthesia with sedation.
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We present the anaesthetic management of a patient for stenting of a thoracic aortic aneurysm at the site of an aortic coarctation. The specific challenges to the anaesthetist for this case are outlined. These include the specific problems of placing the graft, the obvious risk of aortic rupture and the unfamiliar environment of the separate radiological theatre. The advantages and disadvantages to the anaesthetist of the treatment of thoracic aortic aneurysms with stents are briefly discussed.
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Case Reports
Treatment of a case of acute right heart failure by inhalation of iloprost, a long-acting prostacyclin analogue.
Perioperative acute right heart failure after orthotopic heart transplantation contributes significantly to morbidity and mortality. Vasodilators administered intravenously may decrease pulmonary vascular resistance, but also affect systemic circulation. A decrease of mean arterial pressure will result in reduced right coronary blood flow and deterioration of right ventricular performance. ⋯ No profound effect on the systemic vascular resistance was observed (-2.8%). Iloprost inhalation may be an effective alternative to nitric oxide in the intensive care management of acute right heart failure after orthotopic heart transplantation. Due to the prolonged effect on the pulmonary vascular resistance, iloprost is especially useful for extubated patients.
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A postal survey was conducted in order to investigate current practice in airway management amongst Dutch anaesthetists and to investigate the role of recent training and the role of an 'Access to the Airway' airway management course. ⋯ Dutch anaesthetists, who commenced anaesthetic training after 1988, and those who attended the airway management course 'Access to the Airway' are significantly more likely to follow the American Society of Anesthesiologist's Difficult Airway Algorithm and to use adjunctive techniques for airway management.