Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2011
Case ReportsFailed intubating laryngeal mask airway-guided blind endotracheal intubation in a severe postburn contractured neck patient.
Securing the airway in patients with severe post burn contracture of the neck is often challenging for attending anesthesiologists. Fiberoptic bronchoscope (FOB)-guided endotracheal intubation is considered safe and reliable in this situation. ⋯ We report a case of 30 year old female with mentosternal contracture, where the use of ILMA allowed easy ventilation but failed to enable successful ILMA-guided blind intubation despite multiple attempts, the use of recommended Chandey's maneuver and muscle relaxation. Subsequent FOB revealed marked anterior dislocation of laryngotracheal structures, leading to a slippage of the endotracheal tube back to the esophagus.
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Acta Anaesthesiol Belg · Jan 2011
Case ReportsUltrasound as guidance for a combined bilateral supraclavicular and caudal block, in order to reduce the total anaesthetic dose in a two year old child after a pneumococcal sepsis.
We present a case of the combination of a bilateral supraclavicular block and a caudal block in a two year old boy who needed amputations of four extremities after a pneumococcal sepsis. With the use of ultrasound guidance, reduction of local anaesthetic dose could be obtained in order not to reach the toxic dose of the local anaesthetic. Amputations of four extremities is not common practice. A good postoperative pain management is more than a challenge.
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Acta Anaesthesiol Belg · Jan 2011
Randomized Controlled TrialDifferent preloading protocols with constant ephedrine infusion in the prevention of hypotension for elective cesarean section under spinal anesthesia.
Ninety ASA I or II parturients were randomly allocated to three groups: group 10RL, 15RL and 20RL to receive 10, 15 and 20 mL/kg of Ringer's lactate (RL) respectively within 15 minutes (min) before the spinal block. Spinal anesthesia was performed with hyperbaric bupivacaine 12 mg, morphine 100 microg and fentanyl 10 microg. The operating table was tilted to the left and an IV infusion of ephedrine of 3 mg/min was immediately started and continued until umbilical cord clamping in all groups. ⋯ The total amount of ephedrine was 49.9 +/- 13.5, 46.4 +/- 13.4 and 38.4 +/- 8.5 mg in group 10RL, 15RL and 20RL, respectively (p <0.05). The incidence of nausea and vomiting in group 20RL was significantly less than in group 10RL (p = 0.02). It was concluded that preloading with 20 mL/kg of RL prior to spinal anesthesia followed by constant ephedrine infusion 3 mg/min after spinal block reduced the incidence of hypotension and of nausea and vomiting and decreased the total amount of ephedrine.
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Acta Anaesthesiol Belg · Jan 2011
Case ReportsAnesthesia for laparoscopic surgery in a patient with myotonic dystrophy (Steinert's disease): beneficial use of sugammadex, but incorrect use of pethidine: a case report.
Patients with Myotonic Dystrophy show an unpredictable response to several anesthetic drugs including opioids, neuromuscular blocking agents and especially reversal agents like neostigmine. We describe the case of a 40 year old patient with myotonic dystrophy who underwent laparoscopic cholecystectomy and ovarian cyst removal under general anesthesia. The authors suggest the use of the new reversal agent suggamadex, for reversing neuromuscular blockade caused by rocuronium, in patients suffering from neuromuscular disease and especially from Myotonic Dystrophy, because it rapidly and completely reverses any residual neuromuscular blockade, but also underline the increased susceptibility of these patients to opioids.
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Acta Anaesthesiol Belg · Jan 2011
Case ReportsUnintentional side error for continuous sciatic nerve block at the popliteal fossa.
Among all fields of healthcare about 45% of medical errors occur in the operating theatre. Wrong site procedures remain one of the most preventable medical errors. ⋯ The surgical safety checklist was established in 2008 by the world Health organization (WHO) as a part of the "Safe surgery save Lives" initiative. We report in this article a case of wrong sided continuous popliteal sciatic nerve block and discuss the role of the WHO's checklist in preventing wrong side peripheral nerve block and surgery.