Mistaken identity and use of lignocaine: case report

A 22 year old female patient was admitted for diagnostic curettage. She was clinically assessed and all her laboratory results revealed normal findings. Her medical status was categorized as American Society of Anesthesiology I Emergency [ASAIE].Anesthesia and recovery were uneventful until unifocal premature ventricular contractions [PVCs] appeared which later converted into multifocal PVCs and increased in number to 6/min. Lignocaine 2% [Xylocard 2%] was ordered but the nurse handed over lignocaine 20% [Xylocard 20%] to the doctor without reading the concentration and the dose. The full one-gram bolus was intravenously administered by mistake because the treating physician and nurse did not check the loaded Xylocard syringe. The collapsed patient was cared for with the appropriate measures. The patient was closely monitored in the intensive care unit and was later discharged. The necessary steps were taken to prevent the occurrence of similar incidents

Disseminated intravascular coagulopathy diagnosed by computed tomography

A 24-year-old man was brought to casualty after a fall. He suffered from head injury and multiple fractures. On arrival he was apneic and the heart was at a standstill. Resuscitation was successful and the patient was taken to the CT room to assess the extent of his head trauma. At the end of the procedure, maintaining adequate ventilation proved to be very difficult; the blood pressure was rapidly falling and the ECG showed severe bradycardia. Asystole followed and resuscitation was unsuccessful. Postmortem CT scanning of the chest revealed that the tracheobronchial tree was flooded with blood and coagulation profile showed the picture of disseminated intravascular coagulopathy. CT may be useful in the diagnosis of some pathological conditions when autopsy is difficult to perform

Mortality in the surgical intensive care unit

Study of admissions to the surgical intensive care unit [SICU] at King Khalid University Hospital in Riyadh was carried out from 1982 to 1987. There were 1149 surgical admissions, of whom 96 patients died [mortality rate 8.3%]. Eighty-six patients died of multi system and organ failure [MSOF]. Sepsis appeared to be the ultimate cause of death in 54 patients of the organ failure group [62.8%]. Twenty four% of this group had positive blood cultures, and 57% had more than one positive culture site. Gram-negative bacilli and gram-positive cocci were the predominant organisms with only two positive anaerobic cultures. In this study the risk for developing sepsis starts at the age of 50, otherwise our data confirm previous studies on the influence of sepsis and MSOF on mortality in SICU. Recommendations for future improvement in patient's care and investment in antibiotic research are made

Plasma cholinesterase variants in a Saudi population presenting for surgery

The frequencies of abnormal plasma cholinesterase activities and genotypes were evaluated in 977 Saudi surgical patients and 943 [96.5%] were found to have the normal phenotype. Seventy-six patients [8%] had decreased enzyme activity and 34 [3.5%] had different abnormal genotypes. The most common abnormal genotype was the heterozygous occurrence of the usual and the atypical gene [E[u]E[a]], which was found in 23 patients [2.4%]. On the whole, the distribution of phenotypes was similar to that found in most other Caucasian populations. However, there were some indications of an unusually high frequency of the silent allele It is concluded, that of the total of 977 patients investigated, 27 patients [i.e. 2.8%] would have shown an abnormal response had they been given succinylcholine. However, the duration of respiratory insufficiency following a normal intubation dose of succinylcholine [1 mg/kg] would have exceeded 1 h in less than 1% of the patients

Malignant hyperthermia, neuroleptic malignant syndrome and heat stroke: spectrum of a clinical syndrome

Malignant hyperthermia [MH] is a rare disease which occurs in genetically susceptible subjects after exposure to certain anaesthetics. The triggering anaesthetic agent causes abnormal release or re-uptake of calcium Ca[2+] from the sarcoplasmic reticulum. This interferes with the contraction relaxation process with a progressive increase in heat production and reduction of ATP levels. Neuroleptic malignant syndrome [NMS] is an uncommon disorder and occurs after administration of a neuroleptic agent or acute withdrawal of dopamine therapy. This leads to reduced central dopaminergic drive in the striatum and hypothalamus, so, extrapyramidal muscle rigidity with progressive generation of heat occurs. Heat stroke [HS] is due to the transfer of heat from the environment to the body core. This leads to a major insult to the hypothalamus, the temperature thermostat of the body, so there is a progressive increase in body temperature. There are similarities in the pathogenesis, biochemical changes, clinical pictures, complications and accordingly, the management of these potentially fatal syndromes. Dopaminergic agents and bromocriptine are effective in NMS but of no use in MH or HS. Dantrolene, an inhibitor of calcium release from the sarcoplasmic reticulum is the specific treatment for MH. It has also been used successfully in NMS and HS especially if rhabdomyolysis has occurred