Résumé
We report a case of an otherwise healthy; ambulatory 32 year old parturient on combined antiretroviral therapy that developed prolonged muscle weakness needing postoperative artificial ventilation. Despite no preoperative indication of muscle weakness, she developed respiratory insufficiency following general anesthesia with drugs that are deemed safe for her condition. After ruling out all the likely causes for her respiratory insufficiency that needed 12 hrs of artificial ventilation, we address the issue of undiagnosed preoperative muscle weakness as a likely cause for her problem. The role of a preoperative neurological evaluation to caution the anesthesiologist of the likelihood of a possible need for prolonged artificial ventilation following general anesthesia in this subgroup of patients, emphasized
Sujets)
Humains , Femelle , Thérapie antirétrovirale hautement active/effets indésirables , Césarienne , Faiblesse musculaire , Complications postopératoires/induit chimiquement , Complications postopératoires/physiopathologie , Infections à VIH/complications , Ventilation artificielle , Infections à VIH/traitement médicamenteuxRésumé
A new technique to decompress the superior vena cava [SVC] during off pump bi-directional Glenn [BDG] shunts is described. Cerebral protection maneuvers and the safety concerns of the technique are addressed
Sujets)
Humains , Procédures de chirurgie cardiaque , Veine cave supérieure , Communications interauriculairesRésumé
The right ventricular function is compromised in the presence of severe pulmonary hypertension and/or severe right ventricular outflow obstruction. Evolution in the medical and surgical management has improved the outcome in pressure overloaded right ventricle [RV]. This report describes two patients, aged 16 and 4 years. Echocardiogram and cardiac catheterisation revealed a large sub aortic ventricular septal defect [VSD] with elevated pulmonary artery pressures [PAP] in the first case, and pulmonary atresia, VSD, double outlet right ventricle, severely hypoplastic LPA, and a functioning Blalok Tausig shunt in the second case. The anaesthetic challenges of RV support are described, as well as the surgical technique in VSD repair, using valved patch closure to act as a pressure release valve to decompress the RV during hypertensive episodes. An innovative surgical technique for patients with over loaded RV, which were hitherto considered inoperable, is illustrated, emphasizing the role of anaesthetic management