ABSTRACT
Patients with poorly controlled diabetes mellitus have an increased risk of lower limb infection and gangrene. In Malaysia, they frequently present late and are often in septic shock with multi-organ dysfunction. We report on two patients who presented for lower limb amputation in a desperate attempt to control sepsis and save their lives. Both patients were classified as ASA 5. Both patients had successfully undergone surgery under low dose unilateral spinal anaesthesia. The anaesthetic management of these critically ill patients in view of limited resources is discussed.
Subject(s)
Amputation, Surgical , Anesthesia, Spinal/methods , Diabetic Foot/surgery , Acute Disease , Diabetes Complications , Humans , Malaysia , Male , Middle Aged , Sepsis/surgeryABSTRACT
Acute hypersensitivity reactions to chlorhexidine in the operating room are probably more likely to occur during the early phases of anaesthesia because chlorhexidine is often used for cleaning the surgical field or during placement of indwelling catheters. We report a case of an acute hypersensitivity reaction that occurred in the post anaesthetic care unit. Subsequent skin testing suggested sensitivity to chlorhexidine, which had been applied over the vaginal mucosa at the end of surgery. Relevant issues in the investigation of acute hypersensitivity reactions in the post anaesthetic period are discussed.
Subject(s)
Anaphylaxis/chemically induced , Anesthesia Recovery Period , Anesthesia, Local/adverse effects , Anti-Infective Agents, Local/adverse effects , Chlorhexidine/analogs & derivatives , Drug Hypersensitivity/complications , Acute Disease , Aged , Anaphylaxis/diagnosis , Anaphylaxis/therapy , Anti-Allergic Agents/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Blood Pressure/drug effects , Bronchodilator Agents/administration & dosage , Chlorhexidine/adverse effects , Cyanosis/etiology , Drug Hypersensitivity/drug therapy , Epinephrine/administration & dosage , Female , Gelatin/administration & dosage , Humans , Hydrocortisone/administration & dosage , Postoperative Complications/chemically induced , Postoperative Complications/drug therapy , Promethazine/administration & dosage , Serine Endopeptidases/blood , Succinates/administration & dosage , Tryptases , Vagina/surgeryABSTRACT
Although heparin has been a cornerstone of treatment for the prevention of thrombosis, it is limited by its adverse effects and unpredictable bioavailability. Direct thrombin inhibitors are a novel class of drugs that have been developed as an effective alternative mode of anticoagulation in patients who suffer from heparin-induced thrombocytopaenia, and for the management of thromboembolic disorders and acute coronary syndromes. The main disadvantages of the direct thrombin inhibitors are the lack of an antidote or readily available clinical monitoring. The mechanism of action, the properties of direct thrombin inhibitors and their potential to replace currently available anticoagulants are reviewed.
