Journal of anesthesia
-
Journal of anesthesia · Oct 2012
Case ReportsLife-threatening hemorrhagic shock after laparoscopic surgery: a case of postoperative thrombotic thrombocytopenic purpura.
We report the successful management of a female patient who developed postoperative thrombotic thrombocytopenic purpura (TTP) after an uneventful laparoscopic oophorocystectomy. The patient underwent uneventful laparoscopic surgery for ovarian cystoma. One hour after completion of surgery, the patient suddenly went into shock, with her blood pressure dropping to 60/40 mmHg. ⋯ TTP is an idiopathic disorder, known to be triggered by surgical trauma. Postoperative TTP is difficult to distinguish clinically from DIC because of its close similarity with the latter and subtle differences from other postoperative hematological complications. It is important to bear in mind the possibility of postoperative TTP in patients with unexplained hemorrhagic shock after uneventful surgery.
-
Journal of anesthesia · Oct 2012
Propofol attenuates angiotensin II-induced vasoconstriction by inhibiting Ca2+-dependent and PKC-mediated Ca 2+ sensitization mechanisms.
Angiotensin II (Ang II)-induced vascular contraction is mediated by Ca(2+)-dependent mechanisms and Ca(2+) sensitization mechanisms. The phosphorylation of protein kinase C (PKC) regulates myofilament Ca(2+) sensitivity. We have previously demonstrated that sevoflurane inhibits Ang II-induced vasoconstriction by inhibiting PKC phosphorylation, whereas isoflurane inhibits Ang II-induced vasoconstriction by decreasing intracellular Ca(2+) concentration ([Ca(2+)](i)) in vascular smooth muscle. Propofol also induces vasodilation; however, the effect of propofol on PKC-mediated myofilament Ca(2+) sensitivity is poorly understood. The aim of this study is to determine the mechanisms by which propofol inhibits Ang II-induced vascular contraction in rat aortic smooth muscle. ⋯ These results suggest that the inhibitory effect of propofol on Ang II-induced vascular contraction is mediated by the attenuation of a Ca(2+)-dependent pathway and Ca(2+) sensitivity through the PKC signaling pathway.
-
Journal of anesthesia · Oct 2012
Case ReportsSuccessful epidural analgesia for a vaso-occlusive crisis of sickle cell disease during pregnancy: a case report.
We describe a 19-year-old Cameroonian primigravid young woman with sickle cell disease who was admitted to a local hospital in Cameroon where the first author performed his internship gynecology and obstetrics. She presented at 28 weeks of gestation with severe pain in her left leg caused by a vaso-occlusive crisis. ⋯ Lumbar epidural blockade with bupivacaine combined with sufentanil successfully alleviated her severe peripheral ischemic pain induced by a vaso-occlusive crisis caused by sickle cell disease. Until now, only one case report and no clinical trials have been published concerning the use of epidural analgesia for treatment of a vaso-occlusive crisis of sickle cell anemia in a pregnant woman who is not in labor.
-
Journal of anesthesia · Oct 2012
Letter Case ReportsAltered anesthetic requirements and carbon dioxide setpoint in chronic airway obstruction.
Accidental ingestion of a foreign body into either tracheobronchial tree or esophagus is not an uncommon occurrence. However, there is limited literature available on sequelae of post foreign body ingestion--carbon dioxide set point and apneic threshold due to chronic respiratory acidosis. We report a case of chronic airway obstruction in a 14-month-old boy with prior history of battery ingestion and share our experience in the management.