Spontaneous splenic vein aneurysm rupture in the puerperium.

A case of intra- and retroperitoneal haemorrhage after a splenic vein aneurysm rupture is described. A 27-year-old woman complained of chest pain on her first postpartum day. Symptoms were initially suggestive of pulmonary embolism, but within 3 h she developed severe acute abdominal pain, abdominal distension and haemodynamic instability. Ultrasound demonstrated a non-echogenic mass in the abdomen suggestive of a fluid collection and a computed tomography scan confirmed the presence of a lesion at the pancreatic tail. Urgent laparotomy revealed splenic vein rupture near the pancreatic tail. Partial pancreatectomy and splenectomy were performed. The patient subsequently made an uneventful recovery. Histological examination revealed a splenic vein aneurysm and chronic inflammatory changes in the pancreatic tissue. Rupture of a splenic vein aneurysm is a rare event and the diagnosis may present difficulty because its presentation is similar to several other more common conditions. However, rupture of a splenic vein aneurysm should be suspected in any pregnant woman with unexplained abdominal pain or with clear signs of haemorrhage, as delay in diagnosis can have devastating consequences.

Bispectral index monitoring in sevoflurane and remifentanil anesthesia. Analysis of drugs management and immediate recovery.

BACKGROUND: Recent studies have suggested that electroencephalogram bispectral index (BIS) monitoring can improve recovery after anaesthesia and save money by shortening patients postoperative stay. The aim of the study is to evaluate the management of drugs and to measure immediate recovery after anaesthesia with or without BIS monitoring. METHODS: We studied 90 patients undergoing abdominal surgery randomly allocated to one of two groups of 45 each with or without BIS monitoring. Standard monitoring (EKG, arterial oxygen saturation and non-invasive blood pressure) was applied. All groups were monitored with BIS, using electrodes (Zipprep, Aspect Medical Systems) applied to the forehead. In the group 2 the BIS value was blinded to the anaesthesiologist. The BIS value was displayed using Spacelabs Medical BIS Ultraview Monitor. After obtaining baseline values for the BIS index (group 1) and haemodynamic data (all groups) anaesthesia was induced with a bolus dose of remifentanil and TPS, and vecuronium. The anaesthesia was maintained with Remifentanil and Sevoflurane. At standard times BIS, haemodynamic and respiratory parameters were recorded. Recovery times were measured by a study coordinator. Drug consumption was calculated. RESULTS: In group 1 the consumption of Sevoflurane decreased by 40 % while the consumption of remifentanil decreased by 10 % as compared to group 2. The use of vecuronium did not change in the 2 groups. In group 1 the time elapsed from cessation of anaesthetics to orientation decreased significantly. The difference was 5 min, from 11 to 6 min. CONCLUSIONS: BIS monitoring decrease both sevoflurane and remifentanil consumption, when compared to anaesthesia without BIS, with an immediate recovery after sevoflurane and remifentanil anaesthesia.