Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 2006
Case ReportsPerioperative pulse contour cardiac output analysis in a patient with severe cardiac dysfunction.
We describe a patient with severe left ventricular dysfunction simultaneously monitored with pulse contour cardiac output (PiCCO) analysis, a continuous cardiac output pulmonary artery catheter (continuous COPAC) and intraoperative transoesophageal echocardiography (TOE). There was good agreement between cardiac output (CO) measurements obtained by the three techniques prior to cardiopulmonary bypass (CPB). Agreement of CO measurements following CPB was initially pool; but improved following recalibration of PiCCO. ⋯ GEDVI correlated well with CO in the postoperative period. CFI increased more than two-fold following coronary revascularization and milrinone administration, and there was also a temporal relationship between the CFI and the dose of milrinone in the first 24 hours of treatment. Global end-diastolic volume and cardiac function index may be useful additional measures of left ventricular preload and myocardial contractility in patients with severe left ventricular dysfunction.
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Anaesth Intensive Care · Feb 2006
Case ReportsLaryngotracheal hypoplasia--a rare cause of difficult intubation.
Generalized hypoplasia of the larynx and trachea is a very rare condition with only one case reported in the literature. A pregnant woman presented for an emergency laparotomy under general anaesthesia. ⋯ Subsequent investigations demonstrated generalized hypoplasia of the larynx and trachea. In this report, successful anaesthetic management of this case is discussed along with other possible options.
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Anaesth Intensive Care · Feb 2006
Comparative StudyThe yield of lumbar puncture to exclude nosocomial meningitis as aetiology for mental status changes in the medical intensive care unit.
We aimed to evaluate the diagnostic value of lumbar puncture in excluding nosocomial meningitis as the cause of mental status changes in medical intensive care unit patients. We retrospectively reviewed the records of all patients admitted to the medical intensive care unit at our institution over a four-year period who had a lumbar puncture performed during their stay. Patients with central nervous system devices were excluded. ⋯ In no non-HIV subject did lumbar puncture alter management. Lumbar puncture performed in the medical intensive care unit to exclude nosocomial meningitis as the cause of mental status changes has a low yield and rarely changes management. These findings should not be generalized to patients who have sustained head trauma, have undergone neurosurgical procedures, or may be immunosuppressed.
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Anaesth Intensive Care · Feb 2006
Case ReportsRefractory hypotension during combined general and epidural anaesthesia in a patient on tricyclic antidepressants.
We report a case of refractory hypotension that occurred after epidural injection of local anaesthetic, in a patient who was receiving tricyclic antidepressant therapy and was under general anaesthesia. The patient failed to respond to repeated injections of appropriate doses of sympathomimetics, but did respond to high-dose catecholamine infusions. We suggest that epidural anaesthesia should be used with care when combined with general anaesthesia for patients on long-standing tricyclic antidepressant therapy. If refractory hypotension should occur in such patients, the use of direct-acting vasoconstrictors such as noradrenaline should be considered.
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Anaesth Intensive Care · Feb 2006
Case ReportsAnaesthesia for major orthopaedic surgery in a child with an acute tracheobronchial injury.
A 12-year-old boy presented after a motorbike accident with mediastinal and cervical emphysema but no pneumothorax, minor head injury and several fractures including a comminuted open leg fracture. The child had no signs of respiratory compromise and was stable. ⋯ To avoid general anaesthesia and the risks associated with intubation and ventilation, urgent surgery for correction of his orthopaedic injuries was successfully conducted under spinal, epidural and intravenous regional anaesthesia. The surgical and anaesthetic management of tracheobronchial injury is complex and controversial.