Anaesthesia reports最新文献

Management of type 1 diabetes is constantly evolving. Hybrid closed loop technology is replacing multiple dose insulin and continuous subcutaneous insulin infusions as the preferred manner for managing type 1 diabetes in the community. Currently, there are no case reports or clinical guidelines to instruct practitioners on the safe peri-operative use of hybrid closed loop technology for patients requiring emergency surgery. In our case report we present the case of a 15-year-old male patient who required emergency surgery and wanted to continue the benefits of his hybrid closed loop technology in managing his diabetes peri-operatively. In addition, we discuss the strategies we used to overcome the issue of the continuous glucose monitor misreading paracetamol as glucose. Finally, we present the rationale for the guidance of safe peri-operative use of hybrid closed loop technology. This may allow other patients to benefit from continuation of hybrid closed loop technology during emergency surgery.

Oesophagectomy is an established treatment option for the management of oesophageal carcinoma. This procedure results in loss of the lower oesophageal sphincter, which increases the risk of pulmonary aspiration in patients presenting for subsequent surgeries. Consequently, innovative strategies are needed to enhance safety during airway management. Although Sellick manoeuvre (cricoid pressure) is commonly used to mitigate the risk of aspiration, there is limited evidence to support its efficacy. Additionally, cricoid pressure may not be effective in patients who have undergone oesophagectomy because of the altered neck anatomy. In this case series, we present seven post-oesophagectomy patients who underwent ultrasound-guided modified Sellick manoeuvre for airway management. During tracheal intubation with a videolaryngoscope, the gastric conduit in the neck was visualised and compressed with the ultrasound probe, attempting to oppose both walls of the conduit and reduce the risk of regurgitation. This approach addresses the challenges posed by altered anatomy and the limitations of traditional cricoid pressure, potentially enhancing the safety of airway management in these patients. While ultrasound-guided oesophageal compression shows promise as a feasible technique, further studies are needed to validate its effectiveness.

Venous thromboembolic disease remains a leading cause of maternal morbidity and mortality. We report a case of a 30-year-old woman at 37⁺⁶ gestation with a history of thalassaemia intermedia and splenectomy. During pregnancy, she had been managed with frequent blood transfusions and enoxaparin. She was admitted for induction of labour, and during labour, she developed pre-eclampsia with severe features. Despite magnesium sulphate therapy, she had a short self-terminating seizure shortly after an epidural had been sited. A decision to proceed with an urgent caesarean birth under epidural anaesthesia was made. After birth, she had another seizure associated with oxygen desaturation. Bag-valve-mask ventilation was insufficient, prompting conversion to general anaesthesia and tracheal intubation, after which cardiac collapse developed. Resuscitation was initiated and bedside cardiac ultrasound revealed a large clot-in-transit through the right atrium and ventricle, prompting immediate transfer to cardiac theatres for thrombectomy. The thrombus was successfully removed. The patient recovered well and her trachea was extubated the next day. She was discharged in a stable condition 8 days later. This case highlights the critical role of point-of-care ultrasound in the prompt diagnosis of life-threatening conditions and guiding emergency interventions.

Dynamic carotid compression arising from a change in patient position is a rare complication of goitre, with the potential for cerebral ischaemia and infarction. In this report, a 37-year-old woman presented with a multi-nodular goitre with clinical features concerning for transient cerebral ischaemia. The anaesthetic management and neurological monitoring used to mitigate the risk of cerebral ischaemia during thyroidectomy is described and the literature surrounding this rare complication is explored.

A 78-year-old woman with a prosthetic hip dislocation underwent a pericapsular nerve group block for regional anesthesia. The hip spontaneously reduced before manual intervention, likely due to the block's analgesic and muscle-relaxing effects. Compared to other techniques, this block effectively targets hip innervation while sparing motor function. This case highlights its potential for managing hip dislocations safely, especially in patients at risk from sedation.

Patients with facial trauma are complex; difficult airway management is often anticipated and challenging for the anaesthetist. Awake tracheal intubation is the gold standard in the management of predicted difficult airway because of its high success rate and safety profile. We present the case of a patient with facial trauma who underwent orotracheal intubation with combined videolaryngoscopy and flexible bronchoscopy, under conscious sedation with intermittent boluses of ketamine and dexmedetomidine. Videolaryngoscopy showed significant oedema and epiglottic laceration, not diagnosed by the computed tomography scan, with visualisation of a false passage that could have led to a failed intubation and further trauma. Airway management in patients with facial trauma is challenging and should be planned and discussed by a multidisciplinary team. A technique combining videolaryngoscopy and flexible bronchoscopy during awake intubation has previously been described and, when used in this case, was successful.