Fatal intra-operative disseminated intravascular coagulation; extensive Surgery: a case report

Authors present a case of 26 years old female who was having Esophagectomy done due to esophageal perforation secondary to severe corrosive intake strictures. Pre-operative course was uneventful, but during 5 hours of extensive surgery, she developed fulminant disseminated intravascular coagulation [DIG] which was initially managed, but proved to be fatal after 4 hours of ICU stay. Surgeons should be alert that hypercoaguable state can develop in unprepared patients having extensive surgery

Role of alfentanil in maintaining cardio-circulatory stability in pediatric age group anaesthesia: a phase ii comparative study

OBJECTIVE: The aim of our study was to evaluate the efficacy of fentanyl and alfentanil in relation to hemodynamic stability of pediatric patients during routine general anesthesia

PLACE AND DURATION OF STUDY: A prospective double staged clinical trial was conducted at Anesthesia department of the Hospital over a period of 1 year from June 2010 till May 2011

METHODS: Total of 102 children, aged 7.3+/-2.1years, scoring ASA ?-??, undergoing general anesthesia were recruited and randomly divided in two groups. Group A received fentanyl bolus injection while group B received alfentanil. High flow oxygen was followed by inflow of fentanyl and alfentanil administered in the respective groups. The dose was adjusted to 1.5?g/kg for both fentanyl and alfentanyl. Induction was done by 2mg/kg propofol and rocuronium was administered via automatic infusion pump system. Lungs were mechanically ventilated with a mixture of 60 % [NO] nitrous oxide and [O2] oxygen along with 1% isoflurane. Hemodynamic parameters in terms of blood pressure and pulse were recorded before and after intubations

RESULTS: Time for the systolic Blood Pressure to reach its peak value and then to normal i.e.: [51 +/- 16secvs.71 +/-34 sec, 95% CI 1.243-2.458, P 0.01] and [119 +/- 33 sec vs. 74 +/- 31, 95% CI 2.589-4.821, P 0.01] was statistically significant among the two groups. In addition to this, the time for the pulse to reach maximal value and then back to normal i.e., [54 +/- 27sec vs.103 +/- 39, 95% CI 3.035-4.786, P 0.01] and [123 +/-28sec vs. 59 +/-18, 95% CI 3.212-4.789, P 0.01] was also clinically and statistically significant among the two study groups. It shows that fentanyl group patients achieved maximal values of blood pressures and pulse quickly, but retained their peak and returned to baseline levels after a prolonged interval in comparison to the group of patients who received alfentanil

CONCLUSIONS: Alfentanil 1.5-2?g/kg bolus injection dose in children provides a safe circulatory and hemodynamic balance with minimal cardiovascular response and a stable anesthetic state