Anaesthesia and intensive care
-
Anaesth Intensive Care · Apr 2007
Case ReportsPneumothorax in association with spontaneous ventilation general anaesthesia--an unusual cause of hypoxaemia.
A 43-year-old ASA PS II male patient developed a pneumothorax while breathing pontaneously through a supraglottic airway device during a general anaesthetic. Unexplained hypoxaemia occurred after an episode of coughing. ⋯ The pneumothorax responded to conventional management and the patient made an uneventful recovery. We recommend a high index of suspicion in any patient who coughs and later has unexplained hypoxaemia during general anaesthesia, even if a supraglottic airway device has been inserted.
-
Anaesth Intensive Care · Apr 2007
Case ReportsAnaesthesia for robotic-assisted radical prostatectomy: considerations for laparoscopy in the Trendelenburg position.
Two cases of anaesthetic complications after robotic-assisted laparoscopic radical prostatectomy using the da Vinci Remote-Controlled Surgical System are presented. Case 1 describes a patient with post-extubation respiratory distress requiring re-intubation and subsequent ventilation in an intensive care unit. ⋯ Case 2 describes a patient with mild brachial plexus neurapraxia, which was most likely due to compression by shoulder braces (to prevent cephalad sliding) during the exaggerated head-down tilt. For this procedure, the authors recommend limiting the duration and extent of head-down tilt as much as possible, avoiding excessive intravenous fluids and careful positioning of the patient with avoidance of shoulder braces whenever possible.
-
We describe a technique for using a portable ultrasound scanner (38 mm broadband (10-5 MHz) linear array transducer (Sonosite Titan SonoSite, Inc. 21919 30th Drive SE Bothell, WA.)) to guide dorsal penile nerve block in children under general anaesthesia. Real-time scanning is used to guide bilateral injections into the sub-pubic space, deep to Scarpa's fascia either side of the midline fundiform ligament. Scanning can confirm that the local anaesthetic has spread to contact the deep fascia on each side. A subcutaneous wheal of local anaesthetic along the penoscrotal junction completes the block.