Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Case Reports
Cardiac tamponade complicating anaesthetic induction for repair of ascending aorta dissection.
A case is described of a 69-year-old woman with dissection of the ascending aorta who developed cardiac tamponade during induction of anaesthesia. The tamponade was diagnosed by a haemodynamic profile showing approximation of the central venous, pulmonary wedge and pulmonary arterial diastolic pressures, and was treated with rapid surgical intervention and drainage of the haemopericardium. Cardiac tamponade and dissecting aneurysms of the ascending aorta are conditions with contrasting anaesthetic considerations and the problems encountered are discussed.
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Comparative Study
Intraoperative respiratory complications in patients with upper respiratory tract infections.
A retrospective survey of 3,585 patients aged newborn to 20 years was performed to investigate the prevalence of intraoperative respiratory complications in patients with symptoms of upper respiratory tract infections (URIs). There were no significant differences in complication rates between asymptomatic patients (1.61 per 100) and those with symptoms (1.64 per 100); however, patients who were asymptomatic but had a recent history of an URI had a significantly higher complication rate (5.31 per 100; p less than 0.05) than the asymptomatic patients. ⋯ Results from the study suggest no increased risk of respiratory complications for patients presenting with uncomplicated URIs. However, patients who were asymptomatic but had a recent history of an URI showed a significantly increased risk for the development of intraoperative complications.
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An 18-year-old male with Marfan's syndrome underwent surgery for repair of an ascending aortic dissection. The clinical features of this congenital syndrome and the acute management of its complications are described. As elective surgery is frequently required for ocular, musculo-skeletal or cardiovascular problems in people with Marfan's syndrome, patients must be carefully assessed preoperatively for specific complications. ⋯ The commonest causes of sudden death are cardiovascular complications, in particular rupture and dissection of the ascending aorta. Preoperative assessment should include echocardiography to determine the size of the aortic root. The anaesthetic technique chosen should both decrease myocardial contractility and avoid sudden increases in contractility, in order to minimise the risk of aortic dissection or rupture.