Anaesthesia and intensive care
-
Anaesth Intensive Care · Feb 2003
Case ReportsAnaesthesia for caesarean section in a patient with spinal muscular atrophy.
This report describes a 33-year-old primigravid woman with spinal muscular atrophy Type III (Kugelberg-Welander syndrome). Elective caesarean section was performed at 38 weeks gestation under spinal anaesthesia. The implications of spinal muscular atrophy for anaesthesia for caesarean section are described.
-
Anaesth Intensive Care · Feb 2003
Case ReportsPapaverine angioplasty to treat cerebral vasospasm following traumatic subarachnoid haemorrhage.
The management of vasospasm associated with traumatic subarachnoid haemorrhage presents many challenges. We present a 20-year-old male admitted after sustaining a closed head injury complicated by a Fisher grade III traumatic subarachnoid haemorrhage. Despite treatment with intravenous nimodipine he developed a delayed ischaemic neurological deficit due to cerebral arterial vasospasm. The vasospasm was successfully managed with serial papaverine angioplasty.
-
Anaesth Intensive Care · Feb 2003
Case ReportsAngioedema of the tongue due to acquired C1 esterase inhibitor deficiency.
We describe the management of an 83-year-old woman who presented with upper airway obstruction due to angioedema of the tongue. Following definitive airway management, investigation showed a diagnosis of acquired C1 esterase inhibitor deficiency (acquired angioedema) that was considered to be subsequent to haematological malignancy. ⋯ This case report highlights the potential for acquired angioedema to cause upper airway obstruction. The various treatment modalities for acquired C1 esterase inhibitor deficiency are summarized.
-
Anaesth Intensive Care · Feb 2003
Case ReportsAnti-factor Xa monitoring of anticoagulation during cardiopulmonary bypass in a patient with antiphospholipid syndrome.
The activated clotting time (ACT) may be an unreliable monitor of coagulation for patients with the antiphospholipid syndrome. We describe a patient with antiphospholipid syndrome in whom adequate anticoagulation during cardiopulmonary bypass was confirmed by monitoring both the ACT and anti-factor Xa levels. The cardiopulmonary bypass was uneventful, and there were no thrombotic or bleeding complications. The use of anti-factor Xa levels provided confirmation of adequate anticoagulation (and reversal of anticoagulation) that was not possible using the ACT alone.
-
Anaesth Intensive Care · Feb 2003
Consequences of syringe size sensor malfunction in a modern infusion pump.
Prompted by an actual case of potentially life-threatening infusion pump malfunction, we investigated the effects of wire breakage(s) within the syringe size sensor circuit in a Graseby 3400 infusion pump. The circuit wires within the sensor were systematically broken. The syringe sizes recognised by the sabotaged circuit and the actual sizes of syringes inserted into the pump were compared. ⋯ Only 1.3% of the possible wire breakage(s) were recognised as errors by the pump. The infusion rates were not affected in 22.5% of the cases. Wire breakage within the syringe size sensor in infusion pumps is yet another potential source of infusion error, with important safety implications.