Anaesthesia and intensive care
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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 a patient with congenital methaemoglobinaemia and temporomandibular joint ankylosis.
We report a 10-year-old child with congenital methaemoglobinaemia and temporomandibular joint ankylosis who presented for ophthalmic surgery. He had had two previous anaesthetics in another institution. The first was short and uneventful, and no abnormality was noted. ⋯ The patient required prolonged intensive care and tracheostomy. The tracheostomy was ultimately decannulated. Before his third anaesthetic (after referral to the authors' institution) preoperative investigation revealed that the patient, his father and brother all had methaemoglobinaemia.
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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.
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Anaesth Intensive Care · Feb 2006
Comparative StudyPrediction of successful epidural catheter placement by a 'cold test'.
We tested the hypothesis that the patients' feeling of cold sensation down the back during epidural drug administration through the epidural catheter was a reliable predictor of correct epidural catheter placement. In a prospective study of 80 patients, an epidural catheter was placed in the lumbar epidural space. During epidural drug injection, patients were asked to report feeling of the cold sensation in their back by pressing a bell. ⋯ There were no false positive results. Of three patients who had inadvertent dural puncture and had normal saline 5 ml injected through the Tuohy needle, none reported cold sensation. The perception of cold sensation in the back during epidural administration of a test dose and/or subsequent full dose of local anaesthetic is useful in predicting successful epidural catheter placement.