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Carotid endarterectomy in awake patients: safety, tolerability and results

Mendonça,Célio Teixeira; Fortunato Jr,Jerônimo A.; Carvalho,Cláudio A. de; Weingartner,Janaina; Filho,Otávio R. M.; Rezende,Felipe F.; Bertinato,Luciane P.
Fonte: Sociedade Brasileira de Cirurgia Cardiovascular Publicador: Sociedade Brasileira de Cirurgia Cardiovascular
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2014 EN
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26.11%
Objective: To analyze the results of 125 carotid endarterectomies under loco-regional anesthesia, with selective use of shunt and bovine pericardium patch. Methods: One hundred and seventeen patients with stenosis ≥ 70% in the internal carotid artery on duplex-scan + arteriography or magnetic resonance angiography underwent 125 carotid endarterectomies. Intraoperative pharmacological cerebral protection included intravenous administration of alfentanil and dexametasone. Clopidogrel, aspirin and statins were used in all cases. Seventy-seven patients were males (65.8%). Mean age was 70.8 years, ranging from 48 to 88 years. Surgery was performed to treat symptomatic stenosis in 69 arteries (55.2%) and asymptomatic stenosis in 56 arteries (44.8%). Results: A carotid shunt was used in 3 cases (2.4%) due to signs and symptoms of cerebral ischemia after carotid artery clamping during the operation, and all 3 patients had a good outcome. Bovine pericardium patch was used in 71 arteries ≤ 6 mm in diameter (56.8%). Perioperative mortality was 0.8%: one patient died from a myocardial infarction. Two patients (1.6%) had minor ipsilateral strokes with good recovery, and 2 patients (1.6%) had non-fatal myocardial infarctions with good recovery. The mean follow-up period was 32 months. In the late postoperative period...

Fatal Liver Damage After Barium Enemas Containing Tannic Acid

Lucke, Hans H.; Hodge, Kenneth E.; Patt, Norman L.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 30/11/1963 EN
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Tannic acid contained in the barium enema was found to have been the sole known potential hepatotoxin in four of the five cases of fulminating fatal liver failure that occurred in a 213-bed hospital over a period of 27 months. In the other case halothane anesthesia had also been administered. Autopsies (performed on four of the cases) did not suggest viral hepatitis but showed substantially indentical hepatic changes, not unlike those reported in the past following tannic acid exposure. Proof is not claimed that tannic acid was the cause of these deaths, but further investigation regarding the safety of its administration in barium enemas is advocated.

A morphologic study of unexplained hepatitis following halothane anesthesia.

Wills, E. J.; Walton, B.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/1978 EN
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A survey of postoperative jaundice throughout the United Kingdom allowed the detailed analysis of 76 patients with unexplained hepatitis following halothane anesthesia ("halothane hepatitis"). In 16 patients liver biopsy specimens were examined by light and/or electron microscopy to determine whether the liver morphology could aid the differentiation between "halothane" and "acute viral" hepatitis. The mitochondrial changes often claimed to be characteristic of holothane hepatitis were unremarkable in our patients. Since lipid vacuolation and a predominantly centrilobular distribution of necrosis are not classically described in fatal viral hepatitis, the presence of these features in some of our fatal cases was of some diagnostic interest. In general, however, the results of light and electron microscopy in patients with unexplained postoperative hepatitis is considered to have little differential diagnositc value.

LIVER INJURY, LIVER PROTECTION, AND SULFUR METABOLISM : METHIONINE PROTECTS AGAINST CHLOROFORM LIVER INJURY EVEN WHEN GIVEN AFTER ANESTHESIA

Miller, L. L.; Whipple, G. H.
Fonte: The Rockefeller University Press Publicador: The Rockefeller University Press
Tipo: Artigo de Revista Científica
Publicado em 01/11/1942 EN
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Protein-depleted dogs are very susceptible to injurious agents—in particular, chloroform. Methionine given shortly before chloroform anesthesia will give complete protection against chloroform. Methionine (or cysteine plus choline) given 3 or 4 hours after chloroform anesthesia will give significant protection against the liver injury of chloroform anesthesia. Methionine given more than 4 hours after chloroform anesthesia gives no protection against liver injury. Choline alone given before chloroform gives no protection against liver injury. The protein-depleted dogs have livers which are deficient in both nitrogen and sulfur, but sulfur is depleted more than is the nitrogen. The N/S ratio therefore rises. Methionine or cystine feeding promptly makes up this liver sulfur deficit. Viable liver cells are necessary for this uptake of sulfur. Livers of fetuses in utero or of newborn pups tolerate a chloroform anesthesia which will cause fatal liver injury in adults. The nitrogen and sulfur values of these fetus or pup livers are within the high normal values for adults. Blood-forming cells are present in the fetus or pup livers during this period. When these blood islands are eliminated during the 3rd or 4th week of life, the liver then becomes normally susceptible to chloroform liver injury. Methionine or methionine-rich protein digests (e.g. casein) or various proteins by mouth or by vein should prove useful to protect the liver against certain types of injury and to aid in organ repair.

Anesthetic experience of methemoglobinemia detected during general anesthesia for gastrectomy of advanced gastric cancer -A case report-

Cho, Sam Soon; Park, Yong Duck; Noh, Jae Hoon; Kang, Kyoung Oh; Jun, Hee Jung; Yoon, Jin Sun
Fonte: The Korean Society of Anesthesiologists Publicador: The Korean Society of Anesthesiologists
Tipo: Artigo de Revista Científica
EN
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Methemoglobinemia is an uncommon but potentially fatal disorder. Most cases have no adverse clinical consequence and require no treatment, but methemoglobinemia is often overlooked as a cause of low oxygen saturation, and often mistaken for the more common causes of hypoxia by anesthesiologists despite simple bedside tests that indicate the presence of this treatable abnormality. We present a 68-year-old female patient who underwent gastrectomy for advanced gastric cancer with bleeding. In the preoperative period, the patient showed cyanosis and oxygen saturation was 85% by pulse oximeter, but oxygen saturation by arterial blood gas analysis was 100%. After tracheal intubation, the methemoglobin level was 18.3%. Ascorbic acid and methylene blue were administered. During preanesthetic evaluation, the patient had not informed the anesthesiologist that she had been taking dapsone.

Combined epidural anesthesia and ultrasound guided peripheral nerve block for wound revision in a patient with peripartum cardiomyopathy -A case report-

Gong, Tai Kyung; Kim, Seong Su
Fonte: The Korean Society of Anesthesiologists Publicador: The Korean Society of Anesthesiologists
Tipo: Artigo de Revista Científica
EN
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26.21%
Peripartum cardiomyopathy (PPCM) is a rare complication that occurs between the late stage of pregnancy and six months after delivery. PPCM presents as symptoms of left ventricular dysfunction and it can be fatal unless treated promptly. Furthermore, anesthesia and surgery in such patients is a large challenge to anesthesiologists. First and foremost, the maintenance of stable hemodynamics is a major concern. We report a case of combined lumbar epidural anesthesia and both ilioinguinal and iliohypogastric nerve block under ultrasound guided for a wound revision in a 37-year-old woman diagnosed with PPCM after an emergency cesarean section.

Acute, fatal postoperative myocardial infarction after laparoscopic cholecystectomy in a cardiac patient -A case report-

Lee, Jae Jun; Hwang, Sung Mi; Kim, Hyoung Soo; Ryu, Byoung Yoon; Kim, Jin; Jang, Ji Su; Lim, So Young
Fonte: The Korean Society of Anesthesiologists Publicador: The Korean Society of Anesthesiologists
Tipo: Artigo de Revista Científica
EN
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26.1%
This report presents the case of a 63-year-old man who had a myocardial infarction leading to coronary artery bypass graft 2 years earlier who subsequently underwent elective laparoscopic cholecystectomy. After an uneventful operation, the patient developed an acute postoperative myocardial infarction in the recovery room and died 19 days postoperatively. Anesthesiologists should be aware of the rare possibility of acute, fatal postoperative myocardial infarction and consider this complication when they perform the preoperative risk evaluation, anesthesia, and postoperative care for cardiac patients undergoing noncardiac surgery.

Fatal pulmonary embolism and coincidental cerebral infarction after spinal anesthesia -A case report-

Lee, Jong-Yeon; Lee, Su-Yeon; Shin, Inho; Park, Chunghyun; Lee, Byung-Sang; Kim, Min Sung
Fonte: The Korean Society of Anesthesiologists Publicador: The Korean Society of Anesthesiologists
Tipo: Artigo de Revista Científica
EN
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26.28%
A pulmonary embolism and cerebral infarction are the second and third most common acute cardiovascular diseases after a myocardial infarction. Early diagnosis and appropriate management are important clinical challenges. In this case, a fatal pulmonary embolism and extensive cerebral infarction caused cardiac arrest during spinal anesthesia for total hip replacement surgery. Transesophageal echocardiography indicated a pulmonary embolism and brain CT showed large area of acute infarction at right middle cerebral artery territory. Pulmonary CT angiogram revealed massive pulmonary embolism findings. This paper reviews this case and suggests other preventive modalities.

Near-fatal misuse of medical tape around an endotracheal tube connector during inhalation anesthesia in a horse

Gregson, Rachael; Clutton, R. Eddie
Fonte: Canadian Veterinary Medical Association Publicador: Canadian Veterinary Medical Association
Tipo: Artigo de Revista Científica
Publicado em /09/2012 EN
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26.1%
A 7-year-old gelded Irish sports horse weighing 650 kg was anesthetized on 2 consecutive days for lavage of a septic right radio-carpal joint. On both occasions the endotracheal tube connector, which had been bound in medical tape to produce an airtight seal, functioned as a unidirectional valve during mechanical ventilation, retarding expiration, imposing positive end expiratory pressure (PEEP), and probably continuous positive airway pressure (CPAP). The equipment dysfunction was not identified on either occasion despite close inspection prompted by progressive increases in airway pressure and thoracic distension. Whilst the PEEP and CPAP exerted unexpectedly modest cardiovascular effects and the horse recovered uneventfully on both occasions, the improvisation may have proven fatal in a higher-risk subject.

Unexpected and fatal hemodynamic collapse during transapical transcatheter aortic valve implantation -A case report-

Kim, Eun Hee; Lee, Sangmin Maria; Lee, Jong-Hwan; Lee, Sang Hyun; Park, Pyo Won; Gwon, Hyeon-Cheol
Fonte: The Korean Society of Anesthesiologists Publicador: The Korean Society of Anesthesiologists
Tipo: Artigo de Revista Científica
EN
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26.1%
Although transcatheter aortic valve implantation (TAVI) is generally accepted as an alternative or promising treatment option for patients with decompensated cardiovascular disease in an inoperable or high-risk condition, severe hypotension and/or arrhythmia associated with rapid ventricular pacing still poses a challenge to many clinicians. This report describes a 79-year-old patient who experienced fatal hemodynamic collapse, which suddenly developed after a rapid ventricular pacing in spite of pre-administration of vasopressor. The procedure and anesthesia were uneventful until the first rapid ventricular pacing was applied. Following rapid ventricular pacing, his cardiovascular state was severely compromised and could not be recovered. Despite early initiation of extracorporeal membrane oxygenation device and supportive care, he died from heart failure on post-procedure day four.

Torsade de pointes in liver transplantation recipient after induction of general anesthesia: a case report

Chung, Eun-Jin; Jeon, Yun-Seok; Kim, Hyun-Joo; Lee, Kook Hyun; Lee, Ji-Won; Han, Kyoung-Ah; Jung, Seung-Hwan
Fonte: The Korean Society of Anesthesiologists Publicador: The Korean Society of Anesthesiologists
Tipo: Artigo de Revista Científica
EN
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26.21%
Torsade de pointes (TdP) is an uncommon and specific form of polymorphic ventricular tachycardia, associated with a prolonged QT interval. Prolongation of the QT interval is the most widely recognized electrophysiological abnormality in patients with liver cirrhosis. We observed a case of TdP leading to cardiopulmonary resuscitation after the induction of general anesthesia, in a patient with liver cirrhosis scheduled for emergency cadaveric donor liver transplantation. The patient had mild QT prolongation on preoperative electrocardiography with a corrected QT (QTc) interval of 455 ms. Drugs used in the preoperative period can elongate cardiac repolarization. Sevoflurane and 5-hydroxytryptamine type 3 receptor antagonists such as palonsetron, used during general anesthesia may have triggered further QT prolongation, producing a fatal condition such as TdP. More caution and consideration in selecting drugs for anesthetic management are necessary for liver cirrhosis patients, especially in patients with preoperative QT prolongation.

Anaphylaxis from atracurium without skin manifestation

Maitra, Souvik; Sen, Suvadeep; Kundu, Sudeshna (Bhar); Pal, Sugata
Fonte: Medknow Publications & Media Pvt Ltd Publicador: Medknow Publications & Media Pvt Ltd
Tipo: Artigo de Revista Científica
Publicado em //2014 EN
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Anaphylaxis is an acute, potentially fatal allergic reaction involving multi organ system that is triggered by a wide range of antigens with a subsequent release of chemical mediators from mast cells and basophils. Diagnosis is primarily clinical though laboratory studies are helpful in further confirmation. Anaphylactic reactions during anesthesia are rare, but can be fatal if not promptly recognized and treated. Among all drugs commonly used in anesthesia, muscle relaxants are the most notorious to trigger anaphylactic reactions and benzylisoquinolinium group of drugs are known to be less common an offender than the steroidal compounds. We report severe anaphylactic reaction after administration of atracurium that was promptly diagnosed and managed without any further morbidity.

Internal Maxillary Artery Pseudoaneurysm: A Near Fatal Complication of Seemingly Innocuous Pharyngeal Trauma

Hennus, M. P.; Speleman, L.
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
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26.1%
A 2-year-old boy presented with persistent pain and oral blood loss after falling with a toothbrush in his mouth. Initial routine inspection of the oropharynx showed no abnormalities. Recurrent blood loss instigated a reinspection under general anesthesia revealing the head of the toothbrush embedded in the nasopharynx. The toothbrush was removed without problems but several hours later a near fatal rebleeding occurred, requiring aggressive fluid resuscitation. Subsequently, the patient was transferred to our pediatric intensive care unit for further evaluation and treatment. CT angiography (CTA) showed a pseudoaneurysm of the internal maxillary artery which was successfully coiled, and further recovery was uneventful. Pediatric pharyngeal trauma is a common entity with rare, but potentially life-threatening, complications. In case of pharynx lesions, bleeding, and persistent pain, flexible endoscopy by an otolaryngologist is mandatory. In case of persistent bleeding vascular imaging is essential with CTA being a reliable alternative for the more invasive angiography.

Fatal air embolism during sigmoidoscopy performed under spinal anesthesia

Traiki, Thamer Bin; Baaj, Jumana; Al Boukae, Ahmad; Zubaidi, Ahmad
Fonte: Medknow Publications & Media Pvt Ltd Publicador: Medknow Publications & Media Pvt Ltd
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
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Air embolism is an uncommon but potentially catastrophic event that occurs when air enters the vasculature. Because of a scared and friable colorectal mucosa, patients with anastomotic stricture are at an increased risk of complications associated with sigmoidoscopy such as bowel perforation and bleeding. This is a report of fatal air embolism confirmed on an immediate postmortem chest radiograph in a patient with a high colorectal anastomotic stricture undergoing sigmoidoscopy under spinal anesthesia is reported. The literature on air embolism in patients undergoing sigmoidoscopy/colonoscopy is reviewed.

General anesthesia in tetanus patient undergoing emergency surgery: A challenge for anesthesiologist

Mahajan, Reena; Kumar, Amit; Singh, Shiv Kumar
Fonte: Medknow Publications & Media Pvt Ltd Publicador: Medknow Publications & Media Pvt Ltd
Tipo: Artigo de Revista Científica
Publicado em //2014 EN
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26.21%
Tetanus is an acute often fatal disease produced by gram positive obligate anaerobic bacterium Clostridium tetani. Tetanolysin damages local tissue and provides optimal conditions for bacterial multiplication. It is therefore important to perform a wide debridement of any wound suspected of being a portal of entry for the bacteria. Little evidence exists to recommend specific anesthetic protocols. We encountered a child scheduled for fracture both bone forearm with developing tetanus. Initial management done with intravenous (i.v) diazepam, phenobarbitone, and metronidazole. After premedication with midazolam and fentanyl, induction was done by propofol 60 mg, vecuronium 2.5 mg, ventilated with O2+ N2O 50:50 with sevoflurane 2% and tracheal intubation was done with 5.5 ID cuffed PVC endotracheal tube. Anesthesia was maintained with sevoflurane 2% and vecuronium intermittently when required. Intraop vitals were stable. On completion of surgery, reversal given and patient was extubated uneventfully and shifted to recovery room. Little evidence exists to recommend specific anesthetic technique for tetanus patient posted for surgery. When present, obvious wounds should be surgically debrided. Ideally patients considered for surgery should undergo anesthesia and surgery before severe autonomic dysfunction develops. Most anesthetic managements are based on limited evidence. However...

Fatal cardiac thromboembolism in a patient with a pacemaker during ureteroscopic lithotripsy for ureter stone: a case report

Chung, Mee Young; Chae, Su Min; Kim, Chang Jae
Fonte: The Korean Society of Anesthesiologists Publicador: The Korean Society of Anesthesiologists
Tipo: Artigo de Revista Científica
EN
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26.1%
Intracardiac thrombosis is an infrequent and fatal complication in patients with an inserted pacemaker. A patient with an inserted pacemaker scheduled for ureter stone removal experienced cardiac arrest and cardiopulmonary resuscitation under general anesthesia. Echocardiography showed multiple intracardiac thrombi. Preoperative diagnostic workup including echocardiography for the detection of pacemaker lead thrombus, and the need for anticoagulation should be considered in patients with an inserted pacemaker and high-risk factors for thrombosis.

Acute gastric dilatation causing fatal outcome in a young female with eating disorder: a case report

Youm, Seung-Mok; Kim, Ji Young; Lee, Jeong Rim
Fonte: The Korean Society of Anesthesiologists Publicador: The Korean Society of Anesthesiologists
Tipo: Artigo de Revista Científica
EN
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25.93%
A 21-year-old female with a history of bulimia nervosa came to the emergency room due to severe abdominal pain after excessive eating five hours previously. On arrival at the emergency room, extreme abdominal distension was detected and the patient's legs changed color. Computed tomography suggested severe gastric dilatation, so abdominal compartment syndrome was suspected and an emergent laparotomy was supposed to be conducted. Though anesthesia was induced without event, abrupt hemodynamic collapse developed just after the operation started. In spite of active resuscitation for 29 min, the patient did not recover and expired. As the incidence of eating disorders is increasing, anesthesiologists should keep in mind the possibility of abdominal compartment syndrome in patients with a recent history of binge eating, and prepare optimal anesthetic and resuscitation remedies against sudden deteriorations of a patient's condition.

Anaphylaxis following atropine administration during general anesthesia: a case report

Choi, Jaekyu; Kim, Hyunchang; Jeon, Yun-Seok; Hong, Deok Man
Fonte: The Korean Society of Anesthesiologists Publicador: The Korean Society of Anesthesiologists
Tipo: Artigo de Revista Científica
EN
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26.11%
Anaphylaxis is an acute, potentially lethal, multisystem syndrome resulting from the sudden release of mast-cell- and basophile-derived mediators into the circulation. Common manifestations of anaphylactic reactions include urticaria, angioedema, nausea, vomiting, hypotension and cardiovascular collapse. Cardiovascular collapse is the first detected manifestation in up to 50% of cases in perioperative anaphylaxis, because patients are anesthetized and unable to report symptoms. A 25-year-old male presented with severe hypotension and erythema after intravenous atropine administration during general anesthesia. Postoperative laboratory findings demonstrated elevated serum tryptase and total immunoglobulin E. An intradermal test showed atropine sensitivity. Although atropine is used widely as a perioperative anticholinergic agent, it is a potential risk factor for a severe anaphylactic reaction. Therefore, prompt recognition and adequate therapeutic measures are necessary to avoid fatal consequences.

Subdural Hematoma as a Consequence of Epidural Anesthesia

Bishop, Tracy M.; Elsayed, Kareem S.; Kane, Kathleen E.
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Text
EN
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Regional spinal and epidural anesthesia are used commonly in operative procedures. While the most frequent complication, postdural puncture headache (PDPH), is a clinically diagnosed positional headache that is usually self-limited, subdural hemorrhage (SDH) is a potentially fatal complication that cannot be missed. We report a case of an otherwise healthy female who presented with persistent positional headache and was ultimately found to have a large subdural hematoma with midline shift requiring surgical evacuation.

Anesthesia for Ex Utero Intrapartum Treatment: Renewed Insight on a Rare Procedure

Vieira Marques, M; Carneiro, J; Adriano, M; Lança, F
Fonte: Elsevier Publicador: Elsevier
Tipo: Artigo de Revista Científica
Publicado em //2015 ENG
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The ex utero intrapartum treatment is a rare surgical procedure performed in cases of expected postpartum fetal airway obstruction. The technique lies on a safe establishment of a patent airway during labor in anticipation of a critical respiratory event, without interrupting maternal-fetal circulation. Anesthetic management is substantially different from that regarding standard cesarean delivery and its main goals include uterine relaxation, fetal anesthesia and preservation of placental blood flow. We present the case of an ex utero intrapartum treatment procedure performed on a fetus with a large cervical lymphangioma and prenatal evidence of airway compromise. Modifications to the classic ex utero intrapartum treatment management strategies were successfully adopted and will be discussed in the following report.