ABSTRACT
Tracheal perforation following oesophagectomy is a very rare and occasionally life-threatening condition that requires a high degree of suspicion and early intervention for optimal patient outcomes. This article presents a case report of a 46-year-old male who presented with respiratory failure secondary to tracheal perforation at the level of carina following a two-stage oesophagectomy. He underwent a second emergency procedure; the airway was secured with a left-sided double-lumen tube, and tracheal perforation was successfully repaired. This case report will briefly cover the challenges and difficulties faced by anesthetists in the airway management, ventilation, and hemodynamic instability of such patients.
ABSTRACT
Pyoderma gangrenosum is a non-infectious neutrophilic dermatosis that may be either idiopathic or associated with some underlying diseases like inflammatory bowel diseases, SLE, sarcoidosis, vasculitis etc. It can occur in any part of the body but pyoderma gangrenosum involving oral cavity and genital regions presenting as orogenital ulcers would be clinically quite difficult to be distinguished from Sexually Transmitted Diseases (STDS). We present such a case that was initially managed on the lines of sexually transmitted diseases, which later on came out to be pyoderma gangrenosum, after excluding all other diseases having almost same clinical presentations, on the basis of laboratory results and histopathology.
Subject(s)
Oral Ulcer/diagnosis , Penis/pathology , Pyoderma Gangrenosum/diagnosis , Adolescent , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/therapeutic use , Cyclosporine/administration & dosage , Cyclosporine/therapeutic use , Humans , Male , Oral Ulcer/drug therapy , Pyoderma Gangrenosum/drug therapy , Treatment OutcomeABSTRACT
BACKGROUND: The specialty of thoracic anaesthesia has emerged as a scientifically based discipline just 30 years back. At the start of the 20th century empyema and tuberculosis were the main indications for the thoracic surgery. Later on with the introduction of antibiotics lung malignancies were more commonly operated. Recent resurgence of tuberculosis and associated medical illnesses put these patients in high risk for surgery and anaesthesia, necessitating introduction of more skillful approach. The objective of this study was to evaluate the effectiveness of combined thoracic epidural anaesthesia and light general anaesthesia in patients undergoing non-cardiac thoracic surgery. METHODS: This study was conducted at the department of Anesthesia and Intensive care, Pakistan Institute of Medical Sciences, Islamabad from 1st Jan 2001 to 31st August 2002. Ten adult patients of both sexes of ASA grade I-III, < 68 years of age, who were undergoing non-cardiac thoracic surgery were included. Thoracic epidural and central venous lines were placed 20 to 30 minutes before the start of procedure. All patients received same premedication, induction agents, analgesics, inhalational agents and muscle relaxants. All patients were transferred to Surgical Intensive Care unit after completion of the procedure. RESULTS: Seventy percent patients were operated on lungs, twenty percent on mediastinum and one percent for carcinoma of esophagus. Only one patient had co morbid disease of hypertension. One patient (10%) died of massive intraoperative hemorrhage. One patient (10%) developed superior vena caval obstruction, that was to be operated for mediastinal growth. Rest of eight (80%) patients were extubated in the operation theatre. All (100%) patients received intraoperative blood transfusion. 20% patients required additional analgesia in the postoperative period. 20% developed postoperative arrhythmias. CONCLUSION: Combined use of light general anaesthesia and thoracic epidural is effective in patients undergoing non-cardiac thoracic surgery.
Subject(s)
Anesthesia, Epidural , Anesthesia, General , Thoracic Surgical Procedures/adverse effects , Adult , Aged , Female , Humans , Male , Middle Aged , Postoperative Complications/prevention & control , Treatment OutcomeABSTRACT
Malignant hyperthermia refers to covert myopathies, which do not affect the individual during daily life activities, but may lead to life-threatening tachycardia, rigor, labile blood pressure and most importantly high-grade temperature when exposed to general anaesthesia. This conditions is mimicked by thyroid storm, neuroleptic malignant syndrome, phaeochromocytoma and sepsis. We present a presumptive case of malignant hyperthermia.
