ABSTRACT
Entrainment of air following exploration of posterior cranial fossa in the sitting position was studied in five patients. Intracranial pressure was monitored through a ventriculostomy catheter after closure of the dura. In three patients nitrous oxide was added to the breathing mixture only after the baseline intracranial pressure had stabilised following closure of the dura. A marked rise in intracranial pressure was observed immediately. A rapid decrease in intracranial pressure occurred when nitrous oxide administration was stopped. Two patients were nitrous oxide from the beginning. No change in intracranial pressure was noted. Computerised tomogram on the first postoperative day revealed a significant amount of air in eight cases.
Subject(s)
Cranial Fossa, Posterior/surgery , Pneumocephalus/etiology , Skull/surgery , Anesthesia, Inhalation , Humans , Intracranial Pressure , Methods , Nitrous Oxide , Pneumocephalus/diagnostic imaging , Postoperative Complications/diagnostic imaging , Posture , Tomography, X-Ray ComputedABSTRACT
A 32-year-old man with myotonic dystrophy underwent a thoracotomy for removal of a mediastinal thymoma. Pre-operative examination revealed features of myotonic dystrophy, the only other abnormality was mild restrictive pulmonary disease. Anaesthesia was induced with thiopentone and maintained with enflurane, nitrous oxide, oxygen and curare. Following surgery, the patient was mechanically ventilated for several hours and remained intubated for 9 hours. The anaesthesia and surgery were tolerated well; however, postoperative complications included refractory dysrhythmias, hypoxia, pneumococcal pneumonia and pulmonary emboli. More intensive preoperative pulmonary evaluation and physiotherapy coupled with more aggressive postoperative pulmonary care might have resulted in a smoother recovery phase.
