Inguinal herniorraphy is one of the commonest operations in surgical practice performed in patients ranging from paediatrics to elderly age group. It is often performed under spinal anaesthesia which has its limitations due to hemodynamic changes. Hernia block performed using ultrasonography could prove to have technical advantages such as real time imaging of nerve, reduced volume of local anaesthesia and safety in terms of injury to adjacent structures. Our goal is to provide medical education regarding the use of ultrasound-guided ilioinguinal block and to share our experience that how direct visualisation of applied anatomy improves patient care.
{"title":"Ultrasound Guided Ilioinguinal Block","authors":"A. Gupta, N. Aggarwal, D. Sharma","doi":"10.5580/11f6","DOIUrl":"https://doi.org/10.5580/11f6","url":null,"abstract":"Inguinal herniorraphy is one of the commonest operations in surgical practice performed in patients ranging from paediatrics to elderly age group. It is often performed under spinal anaesthesia which has its limitations due to hemodynamic changes. Hernia block performed using ultrasonography could prove to have technical advantages such as real time imaging of nerve, reduced volume of local anaesthesia and safety in terms of injury to adjacent structures. Our goal is to provide medical education regarding the use of ultrasound-guided ilioinguinal block and to share our experience that how direct visualisation of applied anatomy improves patient care.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128404551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Much is understood about the human-technology relationship and the importance of user focused design. This is well recognized in anesthesia with human factors investigations leading to patient safety awareness, regulation, and workload management. Conversely, this has inspired little change in the design of equipment to reduce the awkwardness in providing anesthesia. In fact, it has increased it by not discriminating between normal use and adopted use where the anesthesia profession has, over time, created habits to overcome and accommodate design deficiencies. This study examines past and present anesthesia equipment and use methods to deduce the origin of awkwardness. By describing the latent design cycle in the evolution of anesthesia equipment, a prediction can be provided for the application and acceptance of future technologies in anesthesia. The anesthetic profession may continue with standardized equipment design; conversely, the benefits of innovation in digital technologies to reduce awkwardness will probably be associated with significant change in the convention of use.
{"title":"Describing A Latent Design Cycle In 100 Years Of Innovation And Adoption In Anesthesia Equipment: The Origin Of Awkwardness","authors":"B. Guy, B. Robinson, R. Westhorpe","doi":"10.5580/28c9","DOIUrl":"https://doi.org/10.5580/28c9","url":null,"abstract":"Much is understood about the human-technology relationship and the importance of user focused design. This is well recognized in anesthesia with human factors investigations leading to patient safety awareness, regulation, and workload management. Conversely, this has inspired little change in the design of equipment to reduce the awkwardness in providing anesthesia. In fact, it has increased it by not discriminating between normal use and adopted use where the anesthesia profession has, over time, created habits to overcome and accommodate design deficiencies. This study examines past and present anesthesia equipment and use methods to deduce the origin of awkwardness. By describing the latent design cycle in the evolution of anesthesia equipment, a prediction can be provided for the application and acceptance of future technologies in anesthesia. The anesthetic profession may continue with standardized equipment design; conversely, the benefits of innovation in digital technologies to reduce awkwardness will probably be associated with significant change in the convention of use.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116698240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew M. Kang, Erich G. Anderer, Robert E. Elliott, S. Kalhorn, P. Cooper, A. Frempong-Boadu, S. M. Hesseltine, Y. Ge, Joshua Marcus, M. Law
Objective: Conventional MRI for the evaluation of cervical spondylotic myelopathy (CSM) may be poorly correlated with a patient’s symptoms and prognosis. Interpretation of canal stenosis, contour deformities, and the presence or absence of T2 signal change, can make it difficult to decide who needs decompressive surgery. Diffusion tensor imaging (DTI) provides quantitative measurements that could help clarify the degree and chronicity of spinal cord disease as a result of compression from degenerative spondylosis. DTI can also detect diffusion abnormalities in areas of acute spondylotic compression occurring without T2 signal change. The purpose of this study is to compare these quantitative DTI measures (i.e. metrics) in patients with severe clinical and radiographic evidence of CSM with controls. Methods: DTI of the cervical spine was performed in 11 patients with severe radiographic and clinical multilevel spondylosis who were planned for surgical decompression versus 10 healthy volunteers (as determined by 2 neurosurgeons A.F.B. and P.R.C., and a neuroradiologist M.L.), using pulsed gradient, double spin echo, echo planar imaging. At the C2-3, C3-4 and C4-5 levels, average FA, MD, E1 (longitudinal diffusion), E2 and E3 (transverse diffusion) were calculated within regions of interest at bilateral anterior, lateral, and posterior regions of the cord. Levels caudal to C4-5 were not analyzed due to artifact on DTI. The average age of the spondylosis patients was 67.2±9.8 years vs. 33.4±15.2 years in the control group (p<.001). Results: Fractional anisotropy (FA) and the minor transverse eigenvalues (E2 and E3) most consistently demonstrated significant differences in values between patients with radiographic and clinical CSM versus controls at C4-5. FA was the most specific in correlating with compression seen on conventional T2 imaging at C4-5; however, the minor eigenvalues showed the greatest degree of significant difference in DTI metrics when compared to controls. At C2-3, significant differences in mean diffusivity (MD) were found at the lateral and central regions as well as minor eigenvalue differences in the posterior, lateral, and central regions. There were no significant differences in the major longitudinal eigenvalue (E1) between patients with CSM versus controls. Conclusion: Minor eigenvalues and fractional anisotropy are significantly different in clinically significant spondylosis with conventional imaging evidence of compression versus controls, with preservation of the major eigenvalue. These values show promise as biomarkers of microscopic injury to the cord, which may help in the early identification of patients who would likely benefit from decompressive therapy. DTI can also provide information on the duration of cord compression in helping to distinguish reversible versus irreversible disease. Supported by: Grants RO1CA093992 and RO1111996 from the National Cancer Institute/National Institute of Health.
{"title":"Diffusion Tensor Imaging of the Spondylotic Cervical Spinal Cord: A Preliminary Study of Quantifiable Markers in the Evaluation for Surgical Decompression","authors":"Matthew M. Kang, Erich G. Anderer, Robert E. Elliott, S. Kalhorn, P. Cooper, A. Frempong-Boadu, S. M. Hesseltine, Y. Ge, Joshua Marcus, M. Law","doi":"10.5580/e9b","DOIUrl":"https://doi.org/10.5580/e9b","url":null,"abstract":"Objective: Conventional MRI for the evaluation of cervical spondylotic myelopathy (CSM) may be poorly correlated with a patient’s symptoms and prognosis. Interpretation of canal stenosis, contour deformities, and the presence or absence of T2 signal change, can make it difficult to decide who needs decompressive surgery. Diffusion tensor imaging (DTI) provides quantitative measurements that could help clarify the degree and chronicity of spinal cord disease as a result of compression from degenerative spondylosis. DTI can also detect diffusion abnormalities in areas of acute spondylotic compression occurring without T2 signal change. The purpose of this study is to compare these quantitative DTI measures (i.e. metrics) in patients with severe clinical and radiographic evidence of CSM with controls. Methods: DTI of the cervical spine was performed in 11 patients with severe radiographic and clinical multilevel spondylosis who were planned for surgical decompression versus 10 healthy volunteers (as determined by 2 neurosurgeons A.F.B. and P.R.C., and a neuroradiologist M.L.), using pulsed gradient, double spin echo, echo planar imaging. At the C2-3, C3-4 and C4-5 levels, average FA, MD, E1 (longitudinal diffusion), E2 and E3 (transverse diffusion) were calculated within regions of interest at bilateral anterior, lateral, and posterior regions of the cord. Levels caudal to C4-5 were not analyzed due to artifact on DTI. The average age of the spondylosis patients was 67.2±9.8 years vs. 33.4±15.2 years in the control group (p<.001). Results: Fractional anisotropy (FA) and the minor transverse eigenvalues (E2 and E3) most consistently demonstrated significant differences in values between patients with radiographic and clinical CSM versus controls at C4-5. FA was the most specific in correlating with compression seen on conventional T2 imaging at C4-5; however, the minor eigenvalues showed the greatest degree of significant difference in DTI metrics when compared to controls. At C2-3, significant differences in mean diffusivity (MD) were found at the lateral and central regions as well as minor eigenvalue differences in the posterior, lateral, and central regions. There were no significant differences in the major longitudinal eigenvalue (E1) between patients with CSM versus controls. Conclusion: Minor eigenvalues and fractional anisotropy are significantly different in clinically significant spondylosis with conventional imaging evidence of compression versus controls, with preservation of the major eigenvalue. These values show promise as biomarkers of microscopic injury to the cord, which may help in the early identification of patients who would likely benefit from decompressive therapy. DTI can also provide information on the duration of cord compression in helping to distinguish reversible versus irreversible disease. Supported by: Grants RO1CA093992 and RO1111996 from the National Cancer Institute/National Institute of Health.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125754706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The aim of this double blind, randomized, comparative study was to assess the analgesic efficacy and safety of two different concentrations of ropivacaine and fixed dose clonidine as an adjuvant for pediatric caudal block.Methods: Sixty ASA-I children undergoing elective ilio-inguinal surgery were randomly divided in two groups to receive, caudal injection with 0.1% ropivacaine 1ml/kg and clonidine 2μg/kg in group I or 0.2% ropivacaine 1ml/kg and clonidine 2μg/kg in group II after induction of standard general anesthesia. Intra and post-operatively HR, MAP and RR were monitored. Postoperative duration of analgesia, CHIPPS (Child and infant post-operative pain scale), sedation by Ramsay sedation scale and residual motor blockade by Modified Bromage scale were recorded.Result : There were no significant differences among the two study groups with respect to age, weight or duration of surgery. In both the groups none of patient required additional analgesia or anesthesia intra-operatively. Mean CHIPPS in group I was0.89±0.42 and in group II was 0.94±0.58, p-value 0.69 was statistically non significant .Duration of analgesia in both the groups was statistically not significant. Bradycardia, hypotension, and sedation were not recorded in both the study groups.Conclusion: It was concluded that, addition of clonidine to 0.1% ropivacaine gives similar quality and duration of analgesia as that of 0.2% ropivacaine and clonidine, without causing significant degree of postoperative sedation and motor weakness.
{"title":"Comparison Of Two Different Concentration Of Ropivacaine With Clonidine As Adjuvant, In Caudal Epidural In Pediatric Patients.","authors":"K. Adate, S. Sardesai, S. Thombre, A. Shinde","doi":"10.5580/bf0","DOIUrl":"https://doi.org/10.5580/bf0","url":null,"abstract":"Background: The aim of this double blind, randomized, comparative study was to assess the analgesic efficacy and safety of two different concentrations of ropivacaine and fixed dose clonidine as an adjuvant for pediatric caudal block.Methods: Sixty ASA-I children undergoing elective ilio-inguinal surgery were randomly divided in two groups to receive, caudal injection with 0.1% ropivacaine 1ml/kg and clonidine 2μg/kg in group I or 0.2% ropivacaine 1ml/kg and clonidine 2μg/kg in group II after induction of standard general anesthesia. Intra and post-operatively HR, MAP and RR were monitored. Postoperative duration of analgesia, CHIPPS (Child and infant post-operative pain scale), sedation by Ramsay sedation scale and residual motor blockade by Modified Bromage scale were recorded.Result : There were no significant differences among the two study groups with respect to age, weight or duration of surgery. In both the groups none of patient required additional analgesia or anesthesia intra-operatively. Mean CHIPPS in group I was0.89±0.42 and in group II was 0.94±0.58, p-value 0.69 was statistically non significant .Duration of analgesia in both the groups was statistically not significant. Bradycardia, hypotension, and sedation were not recorded in both the study groups.Conclusion: It was concluded that, addition of clonidine to 0.1% ropivacaine gives similar quality and duration of analgesia as that of 0.2% ropivacaine and clonidine, without causing significant degree of postoperative sedation and motor weakness.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130945773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BackgroundAnxiety is common in surgical patients during the preoperative period. High levels of preoperative anxiety have unfavorable effects on induction and maintenance of anaesthesia as well as on the recovery from anaesthesia and surgery. The incidence of preoperative anxiety for surgical patients in the Niger Delta region is not known, ObjectiveTo determine the factors responsible for preoperative anxiety in surgical patients at the University of Port Harcourt Teaching Hospital, its level and how they can be minimized.MethodAll eligible adult patients admitted for elective surgical procedures within a six-month study period completed a questionnaire on the evening preceding their surgical operations. They were 125 in number. The questionnaire contained a list of items from which the patients selected the anxieties they had. The volunteers assessed the level of their anxieties using the visual analogue scale. Frequency tables were generated for causes of preoperative anxiety, gender, age, educational levels and surgical exposures of the participants. Chi square test was used where appropriate to find out significant difference between two groups. ResultsAbout 90 percent of the participants had one or more anxieties in the preoperative period. Possibility of having the surgical procedure postponed was responsible for preoperative anxiety in the highest number (87) of the volunteers while the least number (10) of them were concerned about postoperative nausea and vomiting. A higher percentage of females than males had preoperative anxiety but this was not statistically significant. Only previous surgical treatment was associated with significantly lower levels of preoperative anxiety (p<.05). ConclusionThe incidence of preoperative anxiety in our surgical population is fairly high. Fear of possible postponement of surgery was the most common anxiety found in this study. Reasons for postponement of elective surgical procedures should be studied. This and other causes of preoperative anxiety for surgical patients should be minimized. Further study of this subject with a larger sample size is suggested.
{"title":"Factors Responsible For Pre-Operative Anxiety In Elective Surgical Patients At A University Teaching Hospital: A Pilot Study.","authors":"L. Ebirim, M. Tobin","doi":"10.5580/1584","DOIUrl":"https://doi.org/10.5580/1584","url":null,"abstract":"BackgroundAnxiety is common in surgical patients during the preoperative period. High levels of preoperative anxiety have unfavorable effects on induction and maintenance of anaesthesia as well as on the recovery from anaesthesia and surgery. The incidence of preoperative anxiety for surgical patients in the Niger Delta region is not known, ObjectiveTo determine the factors responsible for preoperative anxiety in surgical patients at the University of Port Harcourt Teaching Hospital, its level and how they can be minimized.MethodAll eligible adult patients admitted for elective surgical procedures within a six-month study period completed a questionnaire on the evening preceding their surgical operations. They were 125 in number. The questionnaire contained a list of items from which the patients selected the anxieties they had. The volunteers assessed the level of their anxieties using the visual analogue scale. Frequency tables were generated for causes of preoperative anxiety, gender, age, educational levels and surgical exposures of the participants. Chi square test was used where appropriate to find out significant difference between two groups. ResultsAbout 90 percent of the participants had one or more anxieties in the preoperative period. Possibility of having the surgical procedure postponed was responsible for preoperative anxiety in the highest number (87) of the volunteers while the least number (10) of them were concerned about postoperative nausea and vomiting. A higher percentage of females than males had preoperative anxiety but this was not statistically significant. Only previous surgical treatment was associated with significantly lower levels of preoperative anxiety (p<.05). ConclusionThe incidence of preoperative anxiety in our surgical population is fairly high. Fear of possible postponement of surgery was the most common anxiety found in this study. Reasons for postponement of elective surgical procedures should be studied. This and other causes of preoperative anxiety for surgical patients should be minimized. Further study of this subject with a larger sample size is suggested.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121073437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ajuzieogu V.O, Ezike H.A, A. Amucheazi, D. O. Onodugo
A 41-year-old female was booked for guide wire removal under general anaesthesia. She was admitted through the renal unit with a diagnosis of acute renal failure secondary to sepsis. She was scheduled to undergo sessions of haemodialysis. However, the guide wire for cannulation was lost at attempt to gain vascular access for the procedure. An urgent fluoroscopy was done to localize the guide wire and she was then booked for surgery. When all conservative treatment modalities fail, a haemodialysis is indicated in patients with renal insufficiency. For the purpose of haemodialysis, a vascular access with a flow of at least 200ml/minute is needed. Like every other invasive procedure, the process of cannulation is fraught with complications which may include sepsis, kinking of guide wire or inadvertent arterial puncture. 2 Loss of the guide wire itself is rare in the literature. The anaesthesia for the surgical removal of the guide wire as an emergency in a uraemic patient is presented.
{"title":"Anaesthesia For Removal Of Missing Guidewire. A Case Report","authors":"Ajuzieogu V.O, Ezike H.A, A. Amucheazi, D. O. Onodugo","doi":"10.5580/849","DOIUrl":"https://doi.org/10.5580/849","url":null,"abstract":"A 41-year-old female was booked for guide wire removal under general anaesthesia. She was admitted through the renal unit with a diagnosis of acute renal failure secondary to sepsis. She was scheduled to undergo sessions of haemodialysis. However, the guide wire for cannulation was lost at attempt to gain vascular access for the procedure. An urgent fluoroscopy was done to localize the guide wire and she was then booked for surgery. When all conservative treatment modalities fail, a haemodialysis is indicated in patients with renal insufficiency. For the purpose of haemodialysis, a vascular access with a flow of at least 200ml/minute is needed. Like every other invasive procedure, the process of cannulation is fraught with complications which may include sepsis, kinking of guide wire or inadvertent arterial puncture. 2 Loss of the guide wire itself is rare in the literature. The anaesthesia for the surgical removal of the guide wire as an emergency in a uraemic patient is presented.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123265712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We experienced a case in which dexmedetomidine (DEX) was useful in sedation for tracheotomy in a high-risk elderly patient. Use of DEX for sedation during an invasive procedure was approved and monitored by the Research Ethics Committee of Asahikawa Medical College, and informed consent was obtained from the patient’s family. The patient was a 90-year-old male with a weight of 44 kg and height of 151 cm. He had undergone emergency craniotomy for sudden-onset intracranial hematoma one week before. He had been intubated due to continuing consciousness disorder and was scheduled for tracheotomy. He had left hemiplegia and only showed response to painful stimuli and he never opened his eyes or made sounds. Neurosurgeons asked us to perform perioperative management to avoid movement of the patient’s body and also requested spontaneous breathing to be preserved for the following reason: Since a large vein located in his neck where the tracheal cannula would enter the trachea may prevent replacement of the tracheal tube with the tracheal cannula, preserving spontaneous breathing was thought to be preferable in order to gain time until desaturation. We selected DEX for sedation for the tracheotomy since DEX has little effect on the respiratory system.
{"title":"Tracheotomy In Which Dexmedetomidine Alone Was Safely Used In A High-Risk Elderly Patient","authors":"T. Kunisawa, S. Hanada, A. Kurosawa, H. Iwasaki","doi":"10.5580/ad0","DOIUrl":"https://doi.org/10.5580/ad0","url":null,"abstract":"We experienced a case in which dexmedetomidine (DEX) was useful in sedation for tracheotomy in a high-risk elderly patient. Use of DEX for sedation during an invasive procedure was approved and monitored by the Research Ethics Committee of Asahikawa Medical College, and informed consent was obtained from the patient’s family. The patient was a 90-year-old male with a weight of 44 kg and height of 151 cm. He had undergone emergency craniotomy for sudden-onset intracranial hematoma one week before. He had been intubated due to continuing consciousness disorder and was scheduled for tracheotomy. He had left hemiplegia and only showed response to painful stimuli and he never opened his eyes or made sounds. Neurosurgeons asked us to perform perioperative management to avoid movement of the patient’s body and also requested spontaneous breathing to be preserved for the following reason: Since a large vein located in his neck where the tracheal cannula would enter the trachea may prevent replacement of the tracheal tube with the tracheal cannula, preserving spontaneous breathing was thought to be preferable in order to gain time until desaturation. We selected DEX for sedation for the tracheotomy since DEX has little effect on the respiratory system.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"130 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131578132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Krishnamoorthy, Katharina Beckmann, Allen N. Gustin, C. Laurito
Intraoperative hypotension may contribute to significant post-operative morbidity and mortality. We present a case of sudden, profound intraoperative hypotension during Harrington rod revision for scoliosis. During resuscitation of the patient, measurement of the central venous oxygen saturation (CVO2) allowed us to narrow our differential diagnosis. We noted a significantly elevated CVO2 and, in the setting of hypotension, diagnosed intraoperative sepsis. After rod removal and stabilization of the patient's hemodynamics, we cancelled the remainder of the case due to the concern of bacteremia and infection of any newly placed hardware. Cultures from the wound later grew methicillin-resistant staphylococcus aureus. This case highlights the value of central venous oxygen saturation in a clinical picture to diagnose the cause of intraoperative hypotension
{"title":"Intraoperative Hypotension Attributable To Septicemia And Diagnosed By Measurement Of Central Venous Oxygen Saturation","authors":"V. Krishnamoorthy, Katharina Beckmann, Allen N. Gustin, C. Laurito","doi":"10.5580/1660","DOIUrl":"https://doi.org/10.5580/1660","url":null,"abstract":"Intraoperative hypotension may contribute to significant post-operative morbidity and mortality. We present a case of sudden, profound intraoperative hypotension during Harrington rod revision for scoliosis. During resuscitation of the patient, measurement of the central venous oxygen saturation (CVO2) allowed us to narrow our differential diagnosis. We noted a significantly elevated CVO2 and, in the setting of hypotension, diagnosed intraoperative sepsis. After rod removal and stabilization of the patient's hemodynamics, we cancelled the remainder of the case due to the concern of bacteremia and infection of any newly placed hardware. Cultures from the wound later grew methicillin-resistant staphylococcus aureus. This case highlights the value of central venous oxygen saturation in a clinical picture to diagnose the cause of intraoperative hypotension","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123598370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present the case of a patient with extensive Klippel-Trenaunay Syndrome and underlying Kasabach Merritt Syndrome who encountered extensive intraoperative bleeding requiring a massive transfusion of greater than thirty liters of blood and blood products. This case highlights the coagulation challenges posed not only by massive transfusion but also by Klippel-Trenaunay Syndrome with concomitant Kasabach-Merritt Syndrome. This case also notes the value of massive transfusion protocols, while keeping in mind that these have been created from retrospective data.
{"title":"Kasabach-Merritt Syndrome In A Patient With Klippel-Trenaunay Syndrome Undergoing Massive Transfusion.","authors":"J. Bohman, E. Wittwer, T. Curry, W. Hartman","doi":"10.5580/1b71","DOIUrl":"https://doi.org/10.5580/1b71","url":null,"abstract":"We present the case of a patient with extensive Klippel-Trenaunay Syndrome and underlying Kasabach Merritt Syndrome who encountered extensive intraoperative bleeding requiring a massive transfusion of greater than thirty liters of blood and blood products. This case highlights the coagulation challenges posed not only by massive transfusion but also by Klippel-Trenaunay Syndrome with concomitant Kasabach-Merritt Syndrome. This case also notes the value of massive transfusion protocols, while keeping in mind that these have been created from retrospective data.","PeriodicalId":396781,"journal":{"name":"The Internet Journal of Anesthesiology","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2010-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121954530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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