Anaesthesia reports最新文献

Fascial plane blocks for thoracic and neck surgery provide not only peri-operative analgesia but also serve as an effective alternative to general anaesthesia when combined with procedural sedation. Hemithyroidectomies are commonly performed by an open technique involving a transverse neck incision. Minimally invasive endoscopic approaches can offer cosmetic benefits, quicker recovery and reduced need for analgesia. Avoiding general anaesthesia may reduce complications, such as pulmonary atelectasis and cardiovascular instability, which may be of benefit to patients at increased risk. We describe the use of a combination of fascial plane blocks (superficial cervical plexus block, clavipectoral fascia plane block, interpectoral plane block and pectoserratus plane block) and dexmedetomidine sedation for a 65-year-old patient who had previously experienced accidental awareness under general anaesthesia and was very keen to avoid another general anaesthetic. The procedure was uneventful, with minimal bleeding and stable respiratory and haemodynamic parameters throughout. The patient was extremely satisfied with the anaesthetic technique and the cosmetic results of the surgery. We propose that fascial plane blocks along with dexmedetomidine sedation can be an effective alternative to general anaesthesia for endoscopic hemithyroidectomy in selected patients.

Familial amyloidotic polyneuropathy is a rare genetic disorder caused by transthyretin mutations, leading to multi-organ dysfunction, with a significant impact on the nervous and cardiovascular systems. Domino liver transplantation is a unique strategy which increases donor organ availability by transplanting the explanted liver from a patient with familial amyloidotic polyneuropathy into another patient. This report describes a 37-year-old patient with familial amyloidotic polyneuropathy who underwent a living donor liver transplantation as part of a domino liver transplantation, emphasising the lessons learnt about the role of isoprenaline for managing the post-reperfusion syndrome and the considerations regarding prophylactic pacemaker insertion. She developed severe bradycardia following anaesthesia induction and again during graft reperfusion, which was refractory to atropine but successfully managed with isoprenaline. On postoperative day 20, she experienced severe bradycardia which was unresponsive to medical management, necessitating a temporary pacemaker, followed by a permanent pacemaker on postoperative day 26. This case highlights the role of isoprenaline as a preferred agent for managing bradyarrhythmia and conduction blocks during liver graft reperfusion. Additionally, it highlights the potential need for prophylactic pacemaker insertion in select patients with subclinical conduction abnormalities, as stressors, such as liver transplantation, can unmask life-threatening arrhythmias.

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.

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.