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1.
SJA-Saudi Journal of Anaesthesia. 2011; 5 (3): 323-325
em Inglês | IMEMR | ID: emr-129933

RESUMO

Neurogenic pulmonary edema [NPE] is a well-known entity, occurs after acute severe insult to the central nervous system. It has been described in relation to different clinical scenario. However, NPE has rarely been mentioned after endovascular coiling of intracranial aneurysms. Here, we report the clinical course of a patient who developed NPE after aneurysmal rupture during endovascular surgery. There was significant cardiovascular instability possibly from stimulation of hypothalamus adjacent to the site of aneurysm. This case highlights the predisposition of minimally invasive procedures like endovascular coiling to life-threatening complications such as NPE


Assuntos
Humanos , Feminino , Adulto , Aneurisma Intracraniano/complicações , Hemorragia Subaracnóidea/complicações , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/efeitos adversos , Ruptura
2.
Middle East Journal of Anesthesiology. 2010; 20 (4): 571-572
em Inglês | IMEMR | ID: emr-99145

RESUMO

We report a case of a 20 month old male child who underwent surgery for posterior fossa tumor. Post operatively the child developed persistent hypertension. No active intervention was done as it could have compromised cerebral perfusion pressure. The possible cause is discussed


Assuntos
Humanos , Masculino , Lactente , Hipertensão/etiologia , Complicações Pós-Operatórias
3.
Middle East Journal of Anesthesiology. 2009; 20 (2): 309-312
em Inglês | IMEMR | ID: emr-92211

RESUMO

Double aortic arch with patent ductus arteriosus and atrial septal defect is an uncommon association. Such complex cardiac lesions may complicate an otherwise normal anesthetic course. We came across a case with aqueductal stenosis and hydrocephalus, scheduled for ventriculoperitoneal shunt surgery, on an emergent basis. The child was managed successfully. The anesthetic implications of resultant left-to-right shunt with increased intracranial pressure have been described


Assuntos
Humanos , Masculino , Aorta Torácica/anormalidades , Permeabilidade do Canal Arterial , Comunicação Interatrial , Anestesia , Cirurgia Geral , Lactente , Hidrocefalia/cirurgia , Pressão Intracraniana
5.
Middle East Journal of Anesthesiology. 2008; 10 (30): 1041-1053
em Inglês | IMEMR | ID: emr-89082

RESUMO

Subcutaneous tunneling for ventriculoperitoneal shunt insertion is the most painful step of this surgery. It is associated with intense hemodynamic response, may influence the intracranial pressure, and thus may worsen the existing intracranial pathology. The purpose of this report is to evaluate the commonly used opioid fentanyl, along with butorphanol, an agonist-antagonist compound. Twenty adult patients undergoing ventriculoperitoneal shunt surgery were induced with fentanyl 2-mcg.kg[-1] and thiopentone 4-5 mg.kg[-1]. Intubation followed the administration of rocuronium 1 mg.kg[-1]. All patients were put on mechanical ventilation to maintain end-tidal carbon dioxide levels of 32 +/- 2 mmHg. Anesthesia was maintained with isoflurane in N[2]O and O[2] [MAC 1.0 +/- 0.2]. Routine monitoring, arterial blood pressure and intracranial pressures were measured. Three minutes prior to the tunneling phase, patients received either fentanyl 1 mcg.kg[-1] or butorphanol 1 mg in a randomized manner. Thereafter hemodynamic and intracranial pressure changes were noted during tunneling and each minute in the post-tunneling period for 5 minutes. The duration of the tunneling phase was also noted. Data were presented as number [proportion] or mean +/- SD/median [range] as appropriate. Statistical analysis was done using Wilkoxon ranksum test and the repeated measures of ANOVA. The value of p < 0.05 was considered significant. A significant rise in the intracranial pressure and cerebral perfusion pressure along with the hemodynamic parameters was noted during the tunneling phase in both groups. The changes were of longer clinical duration in the butorphanol group. Butorphanol must be used with caution in neurosurgical patients. The ventricular end of the shunt catheter should preferably be put before the tunneling phase to avoid rise in intracranial pressure


Assuntos
Humanos , Masculino , Feminino , Hemodinâmica/efeitos dos fármacos , Fentanila , Butorfanol , Derivação Ventriculoperitoneal
6.
Middle East Journal of Anesthesiology. 2008; 19 (6): 1405-1410
em Inglês | IMEMR | ID: emr-89132

RESUMO

The supraclavicular approach of subclavian vein catheterization is associated with the lowest incidence of malposition. We report two cases of unusual malpositions seen during central venous catheterization of subclavian vein via supraclavicular approach. Literature search did not reveal such malpositions. The possible cause for the malposition and method to prevent it is discussed


Assuntos
Humanos , Masculino , Veia Subclávia , Clavícula , Erros Médicos , Cateterismo/efeitos adversos , Radiografia Torácica
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