Der Anaesthesist
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Patent blue V is widely used as a food dye. Clinically, patent blue V dye has been increasingly used in oncological surgery to identify the sentinel lymph nodes in breast cancer and other malignancies. The case of a patient who developed severe anaphylactic shock to subcutaneous injection of patent blue V during breast surgery is presented. The clinical course and the anesthesiological management are presented, and the pitfalls that may delay the correct diagnosis are highlighted.
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The case of a female patient is reported where difficulty in securing the airway occurred during a reconstructive intervention following partial mandibular resection. During previous surgery the last of which was 2 months prior to this, endotracheal intubation was carried out with the GlideScope videolaryngoscope, but now the vocal chords could not be viewed with the GlideScope. ⋯ A "cannot ventilate, cannot intubate" situation ensued and an emergency tracheotomy was carried out. The case described makes it clear that neither modern devices nor experience from previous anesthesia can reliably guarantee a safe airway management.
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Review Meta Analysis
[Lazarus phenomenon. Spontaneous return of circulation after cardiac arrest and cessation of resuscitation attempts].
In the medical literature the Lazarus phenomenon is defined as the spontaneous return of circulation (SROC) after cessation of cardio-pulmonary resuscitation. Based on published literature recommendations concerning the treatment of patients after cessation of resuscitation and reasons for the Lazarus phenomenon are discussed. ⋯ In the relevant medical literature, the Lazarus phenomenon is a rare occurrence. It seems to be a phenomenon which has often been described in non-medical literature but not published in medical literature. The pathophysiological mechanisms are poorly understood. In the literature several mechanisms are discussed which could be important for this phenomenon, e.g. autopositive end-expiratory pressure, hyperventilation and alkalosis, hyperkalemia, delayed action of drugs and unobserved minimal vital signs. In the literature it is recommended that patients should be passively monitored for at least 10 min after cessation of resuscitation. However, more scientific experimental investigations seem to be necessary to gain a better understanding of this phenomenon.
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Review Case Reports
[False positive death certification. Does the Lazarus phenomenon partly explain false positive death certification by rescue services in Germany, Austria and Switzerland?].
Apart from misdiagnosis, the Lazarus phenomenon, a spontaneous return of circulation after cardiac arrest, is a potential cause for false positive death certification. Because of medicolegal consequences and thus a negative publication bias, the incidence of false positive death certification is unknown. As a false positive death certification results in criminal prosecution and thus media interest, numerous media archives in Germany, Austria and Switzerland were searched for such reports. ⋯ As definite signs of death will not have developed only a few minutes after stopping CPR it might be difficult for an emergency physician to definitely certify a patient's death in an out-of-hospital setting with 100% safety. Thus, prehospital death certification poses a risk of error and subsequent legal prosecution of the emergency physician, as a Lazarus phenomenon may still occur in this phase. Delegation of death certification from emergency physicians to qualified physicians in a follow-up examination might increase both legal safety for emergency physicians in the field and patient safety.