RESUMEN
We report a case of acute pulmonary oedema, consecutive to upper airway obstruction due to the inhalation of the laryngeal mask airway (LMA) bite block during recovery. The LMA was used for general anaesthesia with the bite-block provided in France. No trouble occurred during LMA insertion and anaesthesia. Symptomatic treatment provided complete resolution within a few days.
Asunto(s)
Anestesia por Inhalación/efectos adversos , Máscaras Laríngeas/efectos adversos , Complicaciones Posoperatorias/etiología , Edema Pulmonar/etiología , Enfermedad Aguda , Adulto , Periodo de Recuperación de la Anestesia , Humanos , MasculinoRESUMEN
The authors report the case of a delayed presentation of a traumatic diaphragmatic rupture in a 22-year-old patient admitted to hospital for a minor surgical procedure under general anaesthesia. Nine months before, he had a road traffic accident with a minor thoracic trauma. Three days after surgery, the patient was readmitted for a tension hydrothorax due to the herniation and the perforation of the stomach into the left pleural cavity. Such a delayed presentation of a traumatic diaphragmatic rupture remains uncommon. The peroperative ventilatory factors involved in the development of the hernia are discussed.
Asunto(s)
Diafragma/lesiones , Hernia Diafragmática Traumática/diagnóstico , Accidentes de Tránsito , Adulto , Hernia Diafragmática Traumática/complicaciones , Hernia Diafragmática Traumática/cirugía , Humanos , Masculino , Respiración Artificial/efectos adversos , Rotura , Vólvulo Gástrico/etiología , Vólvulo Gástrico/cirugía , Factores de TiempoRESUMEN
Previous studies on isolated mitochondria have shown an alteration of mitochondrial metabolism by local anesthetics, with an inhibition of adenosine triphosphate synthesis. To show that the same is true for mitochondria intracellularly the effects of the local anesthetic bupivacaine on cellular energy metabolism were studied on cultured fibroblasts. Cells in suspension were analyzed for oxygen consumption using a polarographic method with a Clark electrode, and for cytosol and mitochondrial adenine nucleotides by high performance liquid chromatography. Bupivacaine produced a dose-dependent inhibition of oxygen consumption (50% inhibition at 1.5 mM). After incubation in the presence of bupivacaine, adenosine triphosphate and total adenine nucleotides decreased in the cells, as did the adenylate energy charge. These results demonstrate that bupivacaine interacts with cellular energy metabolism and leads to a depletion of high-energy phosphates. Such intracellular mechanisms could explain in part bupivacaine-induced myocardial depression.
Asunto(s)
Nucleótidos de Adenina/metabolismo , Bupivacaína/farmacología , Consumo de Oxígeno/efectos de los fármacos , Células 3T3/efectos de los fármacos , Células 3T3/metabolismo , Adenosina Trifosfato/metabolismo , Animales , Cromatografía Líquida de Alta Presión , Digitonina/análisis , Líquido Intracelular/metabolismo , Ratones , Modelos Biológicos , PolarografíaRESUMEN
Using the laser dye rhodamine 123, we demonstrated that local anaesthetics can reach mitochondria in cell culture and reversibly decrease, or even collapse, their transmembrane potential. This effect is highly dependent on the lipid-solubility of the local anaesthetic and can be facilitated by the presence of a lipophilic anion.