ABSTRACT
We report a case of tracheal stenosis in a patient with immune thrombocytopenia who presented 4 yr after splenectomy. The 20-yr progression of the stenosis and management, including resection, is charted. The period after resection was complicated by wound infection, surgical emphysema, mediastinitis and dehiscence of the anastomosis of the trachea. The management of patients with tracheal lesions is discussed, but concentrates on airway care after tracheal resection when complications developed. A laryngeal mask airway was used to stabilize an uncuffed tracheal tube at the site of dehiscence.
Subject(s)
Surgical Wound Dehiscence/surgery , Tracheal Stenosis/surgery , Adult , Female , Follow-Up Studies , Humans , Intubation, Intratracheal/adverse effects , Intubation, Intratracheal/methods , Laryngeal Masks , Tracheal Stenosis/etiologyABSTRACT
There are increasing numbers of combined heart-lung transplants being carried out in young people for end-stage pulmonary disease. There have-to-date been few reports of pregnancy in heart-lung transplant recipients. We report on the successful outcome of three pregnancies involving two patients following heart-lung transplantation. The importance of an interdisciplinary approach to the care of such patients throughout pregnancy is clear. The deliveries were carried out by caesarean section under regional anaesthesia and the discussion focuses on the choice of anaesthesia along with the problems these patients present to the anaesthetist. Regional anaesthesia appears to be a safe technique in these patients. However, it is important to appreciate that the response to vasoactive drugs may be unpredictable and that intravenous fluid should be administered carefully as they are at risk of fluid overload and pulmonary oedema.
ABSTRACT
We report on the changes in cerebral near-infrared spectroscopy during grafting of a thoraco-abdominal aneurysm. A 58-year-old man presented with a complex dissecting aortic aneurysm. Repair of the aneurysm was performed under hypothermic circulatory arrest with retrograde cerebral perfusion. Cerebral near-infrared spectroscopy monitoring revealed a reduction in the values recorded for total haemoglobin, oxygenated haemoglobin and cytochrome aa3 along with an increase in deoxygenated haemoglobin during circulatory arrest. When retrograde cerebral perfusion was commenced the signals representing total haemoglobin, oxygenated haemoglobin and cytochrome aa3 were all restored to near baseline values. Deoxygenated haemoglobin, however, remained elevated. These changes support the hypothesis that some cerebral perfusion occurs during retrograde cerebral perfusion.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Thoracic/surgery , Cerebrovascular Circulation , Hypothermia, Induced , Monitoring, Intraoperative/methods , Spectroscopy, Near-Infrared , Aortic Dissection/surgery , Cardiopulmonary Bypass/methods , Humans , Male , Middle AgedABSTRACT
We report a patient in whom delayed weaning from ventilatory support was caused by the malposition of a percutaneous dilational tracheostomy tube. A fold of mucosa, identified at tracheoscopy, was found to be the limiting factor, and the situation was resolved by removal of the tracheostomy and reintubation. We believe that the case supports the routine use of a bronchoscope to check the position of the tracheostomy tube.
