RESUMEN
A 44-year-old man presented for elective laparoscopic adrenalectomy. During the procedure his end-tidal carbon dioxide readings rose steadily. We assumed that this was due to a prolonged carbon dioxide pneumoperitoneum until he developed ST segment depression on his electrocardiogram and a rapid rise in temperature. A diagnosis of malignant hyperthermia was made in view of the rising temperature and carbon dioxide. He responded to cooling and intravenous dantrolene. He was later confirmed to be malignant hyperthermia-susceptible on in vitro contracture testing of a muscle biopsy. The diagnosis was delayed as the early signs of malignant hyperthermia are the same as the expected physiological changes in laparoscopic surgery. As laparoscopic surgery continues to expand we advocate vigilance to ensure early identification of this rare but potentially devastating condition.
Asunto(s)
Adrenalectomía/métodos , Complicaciones Intraoperatorias/diagnóstico , Laparoscopía , Hipertermia Maligna/diagnóstico , Adulto , Dióxido de Carbono/sangre , Humanos , Masculino , Oxígeno/sangre , Presión ParcialRESUMEN
We describe the use of awake fibreoptic intubation in the management of a patient with a known difficult airway, who presented with stridor resulting from supraglottic oedema. The aetiological factors contributing to this supraglottic oedema included coexisting thyroid swelling and congestive cardiac failure. Options for appropriate airway management in such cases are discussed.
Asunto(s)
Edema/complicaciones , Intubación Intratraqueal/métodos , Enfermedades de la Laringe/etiología , Obesidad/complicaciones , Enfermedades de la Tiroides/complicaciones , Edema/patología , Femenino , Humanos , Intubación Intratraqueal/instrumentación , Enfermedades de la Laringe/patología , Persona de Mediana Edad , Obesidad/patología , Ruidos Respiratorios , Enfermedades de la Tiroides/patologíaRESUMEN
We describe the anaesthetic management of a patient who developed life-threatening airway obstruction after trans-jugular liver biopsy. An awake tracheal intubation was performed before anaesthesia was induced and an emergency tracheostomy carried out.
Asunto(s)
Obstrucción de las Vías Aéreas/etiología , Anestesia General/métodos , Biopsia con Aguja/efectos adversos , Hematoma/etiología , Venas Yugulares , Hígado/patología , Biopsia con Aguja/métodos , Hematoma/complicaciones , Hematoma/cirugía , Humanos , Intubación Intratraqueal/métodos , Masculino , Persona de Mediana Edad , Enfermedades Vasculares/complicaciones , Enfermedades Vasculares/etiología , Enfermedades Vasculares/cirugíaRESUMEN
A 60-year-old woman with respiratory failure required ventilatory support using a continuous positive airway pressure face mask. She developed extensive necrosis of the skin of the bridge of the nose. A number of precipitating factors are discussed and suggestions made to minimise the risk of this complication.