European journal of anaesthesiology
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Case Reports
Hypoxic brain damage after intramuscular self-injection of diclofenac for acute back pain.
We present a case of hypoxic brain damage that occurred after intramuscular injection of diclofenac due to a severe anaphylactic reaction. A 38-year-old nurse treated herself for acute lower back pain with 100 mg diclofenac intramuscularly. Five minutes later, she collapsed and developed coma and respiratory arrest. ⋯ Magnetic resonance imaging and computerized tomography showed signs of hypoxic brain injury and the patient died from central cardiopulmonary failure 7 days later. Intramuscular treatment with non-steroidal anti-inflammatory drugs such as diclofenac has rare but potentially severe side-effects. Therefore, intramuscular injections are inappropriate and should be replaced with oral or rectal treatment, which has similar absorption profiles.
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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.
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Case Reports
The anaesthetic management of a case of severe upper airways obstruction due to an enlarging subglottic benign polyp.
The use of a newly developed aid to jet ventilation of the lungs, a modified Ben-Jet tube (the Hunsaker Monjet tube), is described in a patient with partial upper airway obstruction. This report highlights an unusual use of this device. The Monjet is a fluoroplastic, monitored, self-centring, fine bore tube that can be inserted from the mouth through to the subglottic region. It was originally developed to anaesthetize healthy patients without airway obstruction who were undergoing suspension microlaryngoscopy.