Anaesthesia reports最新文献

The rising popularity of facial cosmetic procedures presents new challenges for peri-operative anaesthetic care. We report a case of failed facemask ventilation in a woman with recent dermal filler injections to her cheeks and chin and without any well-described predictors of a difficult airway. After pre-oxygenation and induction of anaesthesia, attempts at facemask ventilation failed to achieve an effective seal as the augmented areas were unusually firm and unyielding, preventing proper mask fit. Despite head optimisation and chin lift, insertion of an oropharyngeal airway and the use of a two-person technique effective ventilation could not be achieved. Early insertion of a second-generation supraglottic airway device restored ventilation and allowed surgery to proceed safely. This case illustrates how dermal fillers can alter facial compliance, obscure anatomical predictors of difficulty, and even be mistaken for allergic swelling. Anaesthetists are encouraged to ask specifically about cosmetic procedures, use inclusive language to promote disclosure and adapt airway plans accordingly.

This case report discusses the anaesthetic management of a patient reliant on a left ventricular assist device who presented with a contained ruptured aortic aneurysm. The placement and removal of the aortic clamp, as well as the blood loss and replacement, constituted a challenge for maintaining cardiac output, optimal pump flow, left ventricular off-loading and avoiding right ventricular failure. Continuous monitoring with transoesophageal echocardiography was a cornerstone for managing the different stages of surgery and for adapting pump revolutions to preload and afterload fluctuations and right ventricular function. Inodilators and vasoconstrictors were used to stabilise sudden fluctuations in haemodynamic parameters. It is important to develop clinical protocols and guidelines for the use of ventricular assist devices to address the complex haemodynamic changes resulting from their use.

Temporal headaches may originate from entrapment of the zygomaticotemporal and the auriculotemporal nerves, which serve as potential trigger points. Conventional interventional management includes local anaesthetic blocks or surgical decompression; however, pulsed radiofrequency of the zygomaticotemporal nerve has not been previously reported. We describe two patients with refractory temporal pain treated with ultrasound-guided pulsed radiofrequency of the zygomaticotemporal nerve. A 54-year-old man with post-traumatic neuralgia achieved sustained relief for over 5 months after two sessions, while a 34-year-old woman with migraine without aura achieved sustained relief for over 4 months after a single session. The block is relatively superficial, has a short learning curve under ultrasound guidance and is well tolerated. Pulsed radiofrequency of the zygomaticotemporal nerve may be considered as a promising minimally invasive and reproducible therapeutic option for patients with temporal headaches.

Seizures during anaesthesia are rare, but potentially serious, especially in paediatric patients. This case report describes a 6-year-old child who developed seizure-induced laryngospasm during inhalational induction of anaesthesia with sevoflurane for adenotonsillectomy. The child exhibited rhythmic upper limbs, jaw and facial twitching accompanied by complete laryngospasm, requiring urgent intervention. A bolus of propofol 50 mg (1.9 mg.kg⁻¹) terminated the seizure, while suxamethonium 40 mg (1.5 mg.kg⁻¹) was required to relieve the laryngospasm and secure the airway. There was no evidence of secretions, regurgitation or inadequate depth of anaesthesia which could have precipitated the laryngospasm. This is the first reported human case of suspected seizure-induced laryngospasm potentially mediated via recurrent laryngeal nerve activation under anaesthesia, a mechanism previously demonstrated only in animals. This observation provides rare clinical support for a neurogenic cause of laryngospasm. Additional cases supporting the proposed mechanism and the pro-epileptogenic potential of sevoflurane are discussed.

Central airway obstruction can be treated with stenting of the airway. A 30-year-old man with known metastatic myxoid liposarcoma presented with central airway obstruction due to tracheal compression from mediastinal metastases. A self-expanding metallic stent was placed under general anaesthesia. During emergence, he developed complete airway obstruction with ensuing hypoxaemia. Emergency intubation was performed and the patient was manually ventilated with high airway pressures to maintain oxygenation. The rigid bronchoscope was reintroduced, which revealed complete collapse of the stent and worsened compression of the upper trachea. The collapsed stent was removed and a silicon stent was deployed, but the compression remained uncorrected. A second partially covered metallic stent was inserted within the silicon stent, overlapping in length. This restored airway patency with an uneventful emergence from anaesthesia.

Headache in pregnancy remains a diagnostic challenge. Neuraxial intervention in the antenatal period can lead to complications, such as postdural puncture headache and subdural haematoma, and may have a significant impact on maternal well-being, labour and birth. Here, we describe a case of headache secondary to intracranial hypotension with onset at 32 weeks of gestation in a 40-year-old woman, 12 weeks following spinal anaesthesia for cervical cerclage. It presented novel problems to consider for the performance of lumbar epidural blood patch and the subsequent neuraxial anaesthesia for the birth. A lumbar epidural blood patch was performed at 38⁺¹ weeks of gestation with full resolution of symptoms, and spinal anaesthesia was subsequently provided the following day for a caesarean birth with good efficacy and no adverse effects. We demonstrated that the low cerebrospinal fluid pressure headache can be effectively and safely managed with a lumbar epidural blood patch, and spinal anaesthesia for caesarean birth may be successfully performed within 24 h of the lumbar epidural blood patch.

This case report describes a 58-year-old man with severe chronic obstructive pulmonary disease and significant cardiac history who underwent laparoscopic appendectomy. During surgery, plethysmography waves with amplitudes exceeding the upper graphical display limit were observed following premature ventricular contractions. These exaggerated waveforms likely resulted from increased stroke volume due to the compensatory pause following each premature ventricular contraction. This phenomenon, though rarely documented, may offer clinical value in understanding peripheral haemodynamic responses to arrhythmia. While similar to the Brockenbrough–Braunwald–Morrow sign described in invasive cardiac studies, this case uniquely demonstrates such findings through non-invasive plethysmography. This observation prompts further exploration into waveform interpretation beyond conventional assumptions in peri-operative monitoring.