RESUMO
Accidental dural puncture (ADP) is a common complication of epidural catheter insertion, and may lead to post-dural puncture headache (PDPH), especially in obstetric patients. Epidural blood patch (BP) is the most effective treatment of PDPH. Prophylactic BP has shown its efficacy to prevent PDPH; nevertheless, this method may be insufficient. We report an ADP case before induction of labor in a 28-year-old parturient. To avoid PDPH, an intrathecal catheter was immediately inserted after ADP and an epidural catheter was also inserted at the interspace above. Catheters were kept in place for more than 24hours. A prophylactic BP was performed immediately after removal of the intrathecal catheter. The patient did not experience any headache. This combination of treatments (intrathecal catheter insertion+prophylactic BP) may be a good alternative approach to prevent PDPH, even if it has to be warranted by other clinical studies.
Assuntos
Anestesia Epidural/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Dura-Máter/lesões , Cefaleia Pós-Punção Dural/prevenção & controle , Adulto , Placa de Sangue Epidural , Cateterismo/efeitos adversos , Feminino , Retardo do Crescimento Fetal/patologia , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , GravidezAssuntos
Pressão Sanguínea , Lesões Encefálicas/complicações , Lesões Encefálicas/terapia , Isquemia Encefálica/etiologia , Isquemia Encefálica/terapia , Dióxido de Carbono/sangue , Circulação Cerebrovascular , Lesões Encefálicas/fisiopatologia , Isquemia Encefálica/fisiopatologia , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We report a video laryngoscopic tracheal intubation under sedation in a patient with a hip fracture. Preoperative assessment revealed signs of difficult airway management linked to a cervical spine immobilization. Here we describe an alternative method to awake fiber optic flexible intubation.
Assuntos
Sedação Profunda/métodos , Intubação Intratraqueal/métodos , Laringoscópios , Laringoscopia/métodos , Idoso de 80 Anos ou mais , Braquetes , Feminino , Fraturas do Colo Femoral/cirurgia , Fraturas Ósseas/terapia , Glote , Humanos , Úmero/lesões , Hipnóticos e Sedativos/administração & dosagem , Hipóxia/etiologia , Hipóxia/terapia , Imobilização , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Traumatismo Múltiplo , Processo Odontoide/lesões , Propofol/administração & dosagem , Fraturas da Coluna Vertebral/terapia , Tentativa de SuicídioRESUMO
OBJECTIVE: Pulmonary embolism remains a leading cause of maternal death in France and in other developed countries. Prevention is well codified, but management remains complex both for diagnosis and therapeutics. The objective of this review was to update the knowledge on diagnosis and treatment of pulmonary embolism during pregnancy. ARTICLE TYPE: Review. DATA SOURCE: Medline(®) database looking for articles published in English or French between 1965 and 2012, using pulmonary embolism, pregnancy, heparin, thrombolysis and vena cava filter as keywords. Editorials, original articles, reviews and cases reports were selected. DATA SYNTHESIS: Pulmonary embolism is one of the leading causes of maternal death in France. Clinical signs and biologic tests are not specific during pregnancy. Doppler ultrasound is helpful for diagnosis and avoids maternal and fetal radiation. Treatment is based on full anticoagulation. Low molecular weight heparin is the treatment of choice. A temporary vena cava filter may be proposed, especially at the end of pregnancy, or when heparin is contraindicated. In case of pulmonary embolism with cardiogenic shock, thrombolysis is an alternative treatment. CONCLUSION: Diagnostic approach is first based on the use of ultrasound- Doppler, and frequently on-to computed tomographic pulmonary angiography or ventilation-perfusion lung scanning. The treatment is based on low molecular weight heparin. Others therapeutics, such as thrombolysis or temporary vena cava filter, may be useful in certain circumstances.
Assuntos
Complicações na Gravidez/diagnóstico , Embolia Pulmonar/complicações , Anticoagulantes/uso terapêutico , Feminino , Fibrinolíticos/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Gravidez , Complicações na Gravidez/tratamento farmacológico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamento farmacológico , Choque Cardiogênico/complicações , Choque Cardiogênico/tratamento farmacológico , Ultrassonografia Doppler , Filtros de Veia CavaRESUMO
We report the use of continuous spinal anesthesia for hip fracture surgery in a patient with pulmonary arterial hypertension. Preoperative evaluation, anesthetic technique and preoperative monitoring are discussed.
Assuntos
Raquianestesia , Fraturas do Quadril/cirurgia , Hipertensão Pulmonar/complicações , Idoso de 80 Anos ou mais , Cateterismo Venoso Central , Hipertensão Pulmonar Primária Familiar , Humanos , Hipertensão Pulmonar/terapia , Masculino , Monitorização Intraoperatória , Procedimentos OrtopédicosRESUMO
AIM: As optimizing glucose control in critically ill patients remains a challenge for intensive-care physicians, this study aimed to determine the accuracy of glucose measurements. METHODS: The accuracy of capillary and arterial blood glucose meter measurements was compared with central laboratory arterial glucose measurements; the factors associated with inaccurate measures were also determined. RESULTS: Altogether, 302 samples from 75 patients were assessed. Mean glucose levels were 126±52 mg/dL for capillary measurements, 133±50 mg/dL for arterial measurements and 143±54 mg/dL for serum glucose laboratory measurements. Compliance with the ISO 15197 guidelines was observed in 74.8% of the capillary samples and 88.7% of the arterial samples. However, all measurements by glucose meter (with either capillary or arterial samples) led to underestimations of serum glucose. CONCLUSION: In critically ill patients, glucose measurements from capillary and arterial blood by glucose meter are inaccurate, and can potentially lead to inappropriate use of insulin-infusion protocols and failure to achieve glycaemic targets.
Assuntos
Artérias , Glicemia/metabolismo , Capilares , Estado Terminal , Diabetes Mellitus/sangue , Insulina/sangue , Monitorização Fisiológica/métodos , Idoso , Cuidados Críticos/métodos , Diabetes Mellitus/tratamento farmacológico , Feminino , Humanos , Infusões Intravenosas , Insulina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito/normas , Valor Preditivo dos Testes , Reprodutibilidade dos TestesAssuntos
Intubação Gastrointestinal/instrumentação , Adulto , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Hematoma Subdural/etiologia , Hematoma Subdural/cirurgia , Humanos , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/métodos , Laringoscopia , Masculino , Falha de TratamentoRESUMO
Only nonionic contrast media are allowed for intrathecal use because of their lower neurotoxicity. In case of inadvertent intrathecal administration of an ionic contrast medium, the typical following syndrome is called ascending tonic clonic seizure syndrome. We describe the case of a 61-year-old woman with low back pain who underwent myelography. Ioxaglate, a water-soluble ionic low osmolar contrast medium was accidentally injected intrathecally. She first presented encephalic signs of neurotoxicity, followed by opisthotonic spasms and respiratory distress. In our case, ioxaglate is a low osmolar agent, leading to early encephalic toxicity (preceding medullary signs), because of its cephalic migration. The patient was successfully treated by sedation, anticonvulsant therapy and fluid hydration. Intrathecal administration of an ionic contrast medium is clearly contraindicated. In case of inadvertent injection of a low osmolar product, encephalic signs are seen first.