ABSTRACT
Carcinoid tumors with hepatic involvement can produce intense flushing, tachycardia, hypotension or hypertension and diarrhoea. Patients with limited cardiac reserve may not tolerate these effects under anaesthesia. Valvular heart disease associated with carcinoid tumors has been reported, but there is no record in the literature of such an association with coronary artery disease. This report presents the anaesthetic management of a patient with coronary artery disease and carcinoid tumor undergoing myocardial revascularization. Emphasis is placed on the rational use of anaesthetic and adjunctive agents which will minimize the incidence of carcinoid symptons. The salient features of the management are prevention of release of vasoactive substances by the use of promethazine hydrochloride during operation, the avoidance of stropine, prophylactic administration of corticosteroids and smooth induction of anaesthesia by the use of diazepam and dimethyl-tubocurarine iodide (Metocurine).
Subject(s)
Anesthesia, General , Carcinoid Tumor/complications , Coronary Artery Bypass , Coronary Disease/surgery , Liver Neoplasms/complications , Aged , Coronary Disease/complications , Humans , Intubation, Intratracheal , Male , Preanesthetic Medication , Tubocurarine/analogs & derivatives , Tubocurarine/pharmacologySubject(s)
Anesthesia, General/instrumentation , Adult , Female , Fentanyl , Humans , Nitrous Oxide , Respiration, Artificial , Thiopental , TubocurarineABSTRACT
Fresh gas flow from the anaesthetic machine can be set to determine the low level of PaCO2 that is achieved during anaesthesia using Rees variation of the T-piece. It does not however set the upper limits for PaCO2 which is more reliant upon the minute ventilation. For a PaCO2 of 40 mm Hg, it is suggested that the fresh gas flow from the machine be 220 cc/kg. For small infants, a higher flow rate is necessary.
Subject(s)
Anesthesia, Inhalation/instrumentation , Carbon Dioxide , Adolescent , Child , Child, Preschool , Humans , Infant , RespirationSubject(s)
Obesity/therapy , Oxygen/blood , Positive-Pressure Respiration , Adult , Humans , Ileum/surgery , Jejunum/surgeryABSTRACT
This is a report of a case of a diffuse bleeding tendency in a pregnant woman who presented for emergency splenectomy with a tentative diagnosis of thrombotic thrombocytopenic purpura. The influence of multiple organ dysfunction in the selection of appropriate monitors and the anesthetic technic in such cases are complex.
Subject(s)
Anesthesia , Hemorrhagic Disorders/surgery , Pregnancy Complications, Hematologic/surgery , Adult , Anesthesia, Inhalation , Female , Hemorrhagic Disorders/etiology , Humans , Nitrous Oxide , Oxygen , Pregnancy , Purpura, Thrombotic Thrombocytopenic/surgery , SplenectomyABSTRACT
A collaborative retrospective study undertaken to investigate cardiac arrest related to pediatric anesthesia in seven institutions between 1960 and 1972 showed 73 instances in which anesthesia was thought to have been either directly responsible or had played an important contributing role. About two thirds of these patients were successfully resuscitated. Cases were found to fit into one of two major categories: cardiovascular and respiratory. Among cardiovascular factors, blood loss, preoperative anemia, inappropriate administration of succinylcholine, and accidental administration of potassium were important contributing causes. Respiratory factors included failure to maintain a patent airway and ventilatory problems. In retrospect, most of these accidents were preventable. Such information should indicate where research emphasis needs to be placed and that our current methods of teaching and training need to be reevaluated.
Subject(s)
Anesthesia/adverse effects , Heart Arrest/etiology , Adolescent , Adult , Age Factors , Anemia/complications , Anesthesia/mortality , Child , Child, Preschool , Heart Arrest/chemically induced , Heart Arrest/mortality , Humans , Hypotension, Controlled , Infant , Infant, Newborn , Preoperative Care , Resuscitation , Retrospective Studies , Succinylcholine/adverse effects , Surgical Procedures, Operative/mortalityABSTRACT
Pancuronium bromide was used safely as the muscle relaxant for neonatal anaesthesia. No untoward effects were seen and the neuromuscular block was successfully reversed in all patients. The potency ratio of pancuronium as compared with tubocurarine ranged from 9:1 at birth to 6:1 at one month of age.
