Pattern of Perioperative Cardiac Arrests at University of Maiduguri Teaching Hospital

Perioperative cardiac arrests and death on the table represent the most serious complications of surgery and anaesthesia. This paper was designed to study their pattern; causes and outcomes following cardiopulmonary resuscitation (CPR) and intensive care unit (ICU) management in our institution. Three year retrospective review of perioperative cardiac arrests and death on operating table following surgical procedure under anaesthesia. For each cardiac arrest or death on the table the sequence of events leading to the arrest was evaluated using case notes; anaesthetic chart and ICU records. Study variables which include demographic data; ASA score; anaesthetic technique; causes and outcome were analysed and discussed. Fourteen perioperative cardiac arrests were encountered following 4051 anaesthetics administered over the three year study period. Twelve out of the fourteen cardiac arrests occurred following general anaesthesia; while the remaining two occurred following spinal anaesthesia. There was no cardiac arrest following local anaesthesia. Children suffered more cardiac arrest than adults.ASAclass III and IV risk status suffered more arrests than ASA I and II. Hypoxia from airway problems was the commonest cause of cardiac arrest followed by septic shock. Monitoring with pulse oximeter was done in only 4 out of the 14 cardiac arrests. Only 2(14) out of 14 cardiac arrests recovered to home discharge; one of them with significant neurological deficit. Majority of arrests were due to hypoxia from airway problems that were not detected early. There is need to improve on patient monitoring; knowledge of CPR and intensive care so as to improve the outcome of perioperative cardiac arrest

Reversible cortical blindness following successful surgical repair of two stab wounds in the heart

This report describes a case of cortical blindness that followed successful surgical repair of two stab wounds in the heart in a 29-year old Libyan man. The patient presented in a state of pre cardiac arrest [shock and low cardiac output status], following multiple chest stab wounds. Chest tube was immediately inserted. Surgery was urgently performed suturing the two wounds; in the root of the aorta and in the left ventricle, and haemostasis was secured. Cardiac arrest was successfully prevented. The patient recovered smoothly, but 24 hours later he declared total blindness. Ophtalmic and neurological examinations and investigations that included fundoscopy, Electroencephalograms [EEGs] and Computed Tomography Scans revealed no abnormalities, apart from absence of alpha waves in the EEGs. We diagnosed the case as cortical blindness and continued caring for the patient conservatively. Three days later, the patient regained his vision gradually and was discharged on the 7[th] postoperative day without any remarks

Perfusión cerebral regional en recién nacidos sometidos a reconstrucción del arco aórtico: descripción de la técnica en dos entidades diferentes / Regional brain perfusion in newborn underwent to an aortic arch repair: description of the technique used in two different entities

Introducción: Recientemente se ha descrito una técnica de perfusión cerebral regional (PCR) que permitiría suprimir o al menos acortar el tiempo de paro circulatorio con hipotemia profunda (PCHP). Nuestro objetivo es comunicar la técnica de PCR empleada en dos entidades clínicas diferentes. Pacientes y métodos: Dos recién nacidos portadores de hipoplasia de corazón izquierdo e interrupción del arco aórtico, respectivamente, fueron sometidos a reparación completa con técnica de PCR, perfundiendo el cerebro a través de un tubo protésico implantado en la arteria innominada, con utilización de circulación extracorpórea e hipotemia profunda. Resultados: En ambos pudo hacerse una corrección muy satisfactoria y la PCR no agregó dificultad al procedimiento, acortándose ostensiblemente el tiempo de PCHP. Los dos pacientes fueron dados de alta sin evidencias de déficit neurológico. Conclusión: La PCR es un método reproducible, que permite acortar o suprimir la necesidad de PCHP en pacientes sometidos a reconstrucción del arco aórtico