Résumé
Operating room fires, though rare, can involve substantial morbidity and mortality. Surgical fires require an ignition source, oxidizer, and fuel. Ignition sources generally include lasers and electrocautery, oxidizer are usually oxygen, nitrous oxide, and ambient air, whereas fuels are classically surgical drapes, materials, and prepping agents. We experienced a patient who, during skin incision, sustained burns resulting from a fire in the operating room. Shortly after application of disinfectants and placement of the surgical drapes, the surgeon used the electrosurgical unit on the incision. In this case, the use of an alcohol-based disinfectant was the major contributing factor to the surgical fire. To avoid recurrence, if alcohol is used for skin prepping, it should be allowed to dry completely before draping.
Sujets)
Humains , Brûlures , Désinfectants , Électrocoagulation , Incendies , Mortalité , Protoxyde d'azote , Blocs opératoires , Oxygène , Récidive , Peau , Champs chirurgicauxRésumé
Perioperative cerebrovascular accidents after general anesthesia are rare but devastating, and are often fatal. We experienced a case of acute cerebral infarction found at 2 days after general anesthesia. A 64 year old, ASA physical status II, hypertensive male patient underwent radical neck dissection due to right thyroid cancer. Anesthesia was induced with propofol and succinylcholine and maintained with vecuronium-enflurane-nitrous oxide-oxygen. No special event occurred during anesthesia, except for of three hypotensive events that required ephedrine. On the second day after the operation, he complained dysarthria and left facial weakness. Brain CT and MRI revealed an infarction of the right middle cerebral artery territory. He was transferred to the department of neurology and received conservative care. Fortunately, he was discharged at 20 days after surgery with much improved symptoms.
Sujets)
Humains , Mâle , Adulte d'âge moyen , Anesthésie , Anesthésie générale , Commémorations et événements particuliers , Encéphale , Infarctus cérébral , Dysarthrie , Éphédrine , Infarctus , Imagerie par résonance magnétique , Artère cérébrale moyenne , Évidement ganglionnaire cervical , Neurologie , Propofol , Accident vasculaire cérébral , Suxaméthonium , Tumeurs de la thyroïdeRésumé
BACKGROUND: It is difficult to manage the symptoms of neuropathic pain, especially alloynia. The mechanism of the induction and maintenance of mechanical allodynia has been extensively researched for several decades. N-methyl-D-aspartate (NMDA) receptor antagonists are known to reduce mechanical allodynia. Recently, the role of prostaglandins in spinal nociceptive processing has been the focus of attention. Therefore, the present study was designed to investigate the effect of a combination of ketamine, a non-competitive NMDA antagonist, and of ketorolac, non-selective cyclooxygenase (COX) inhibitor on mechanical allodynia. METHODS: Male SD rats were prepared by tightly ligating the left L5 and L6 spinal nerves. All rats developed mechanical allodynia 7 days after surgery. N group (control, n = 6) received 5 ml of 0.9% normal saline intraperitoneally. K group (n = 6) received ketamine 1 mg/kg. T group received ketorolac 30 mg/kg, and KT group received ketamine 1 mg/kg and ketorolac 30 mg/kg simultaneously. Paw withdrawal thresholds to von Frey hairs were measured before and at 15 min, 30 min, 60 min and 120 min after drug administration. RESULTS: Normal saline and ketamine 1 mg/kg did not increase the paw withdrawal threshold from baseline. Ketorolac 30 mg/kg increased the paw withdrawal threshold only at 120 min after intraperitoneal injection. However, the co-administration of ketamine 1 mg/kg and ketorolac 30 mg/kg increased the paw withdrawal threshold significantly from baseline for 120 min. CONCLUSIONS: Intraperitoneal injection of ketamine and ketorolac attenuated the mechanical allodynia developed by spinal nerve ligation. Therefore, we suggest that combination of ketamine and ketorolac might be useful for the management of neuropathic pain.
Sujets)
Animaux , Humains , Mâle , Rats , Poils , Hyperalgésie , Injections péritoneales , Kétamine , Kétorolac , Ligature , N-Méthyl-aspartate , Névralgie , Prostaglandin-endoperoxide synthases , Prostaglandines , Nerfs spinauxRésumé
The fulminant malignant hyperthermia (MH) is now encountered less frequently because of increased awareness of the condition by anesthesiologist and better use of mornitoring facilities. Thus there is also an increase in the number of aborted cases, in which anesthesia is stopped and treatment instituted as soon as MH is thought to be likely. We presented a case of an abortive MH in 18 years old male patient during the discectomy on the third and fourth lumbar intervertebral spaces. Anesthesia was induced with thiopental sodium and succinylcholine and then maintained with nitrous oxide, oxygen and enflurane. After induction, there were persistent tachycardia, elavation of end-tidal CO2 tension on capnography, spontaneous tachypnea, body temperature elevation up to 38.2oC, respiratory acidosis and highly level of CPK, myoglobulin in serum and urine. Under the suspicion of MH, all anesthetics were discontinued and vigorous emergency treatment was attempted including ventilation with high flow of 100% oxygen (8 l/min), changing all anesthetic circuits, and cooling measurements such as chilled intravenous solution infusion, gastric lavage with cold saline, alcohol and ice water pack over the body. Fourtunately, he recovered well and discharged without complications.
Sujets)
Adolescent , Humains , Mâle , Acidose respiratoire , Anesthésie , Anesthésie générale , Anesthésiques , Température du corps , Capnographie , Discectomie , Traitement d'urgence , Enflurane , Fièvre , Lavage gastrique , Glace , Hyperthermie maligne , Protoxyde d'azote , Oxygène , Suxaméthonium , Tachycardie , Tachypnée , Thiopental , Ventilation , EauRésumé
Pulmonary alveolar proteinosis is characterized by the remittent or progressive accumulation of lipid-rich proteinaceous material within the alveolar sacs in the absence of inflammatory response. Whole-lung lavage is the only consistent treatment for pulmonary alveolar proteinosis. We have utilized whole-lung lavage for the successful treatment of a 62 year-old female patient with pulmonary alveolar proteinosis. There was no persistent complication during the procedure and the postanesthetic recovery except temporary fever and hypoxic event. The patient was symptomatically, physiologically, and radiologically improved within days after the procedures.
Sujets)
Femelle , Humains , Adulte d'âge moyen , Fièvre , Protéinose alvéolaire pulmonaire , Irrigation thérapeutiqueRésumé
Epidural anesthesia is a technique of regional anesthesia in which the spinal nerves are blocked as they pass through the epidural space. The current study was conducted to determine the extent of contamination of epidural catheters and to attempt to idntify the factors contributing to contamination. The catheters removed from fifty patients were studied, two cultures were taken from each catheter and the following results were obtained. 1) Catheter tips(20%) in ten cultures and portions of the catheter located in the subcutaneous tissue in nine cultures(18%) were found to be contaminated. 2) Staphylococcus epidermidis was found in eight patients, and staphylococcus aureus and xanthomonas maltophilia were found in two patients each other. 3) In the contaminated populations, no significant difference between the growth rate of organisms and the factors in relation to the duration of catheter implantation, age of the patients and the site of catheter inserition was found.