{"title":"Quality improvement in paediatric preoperative screening: a Japanese perspective","authors":"A. Sueda, T. Kagawa, T. Kojima","doi":"10.1002/anr3.12267","DOIUrl":"10.1002/anr3.12267","url":null,"abstract":"","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"11 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139032842","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}
S. Silwal, D. Shrestha, G. Neupane, R. Rana, S. Bhurtel, P. Adhikari, N. Khadka
{"title":"Awake tracheal intubation in a patient with a post-burn contracture performed via direct laryngoscopy in a resource-limited setting","authors":"S. Silwal, D. Shrestha, G. Neupane, R. Rana, S. Bhurtel, P. Adhikari, N. Khadka","doi":"10.1002/anr3.12265","DOIUrl":"https://doi.org/10.1002/anr3.12265","url":null,"abstract":"","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"11 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138485163","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}
{"title":"Incorrect community dosing leading to high apixaban levels in a patient with a hip fracture","authors":"M. A. Clayton-Smith, R. Brown","doi":"10.1002/anr3.12266","DOIUrl":"https://doi.org/10.1002/anr3.12266","url":null,"abstract":"","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"11 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138473385","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}
Many patients with orthotopic heart transplantation later undergo non-cardiac surgery. Historically, neuraxial anaesthesia has been avoided in these patients because the denervated heart is unable to compensate for hypotension via the baroreceptor reflex. Here, we present the cases of two patients with prior heart transplantation who underwent total hip arthroplasty under spinal anaesthesia with intravenous sedation. In both cases, this technique was well-tolerated haemodynamically. We propose that spinal anaesthesia with intravenous sedation can be a safe and efficacious anaesthetic technique for selected patients with a history of orthotopic heart transplantation, with careful intraoperative fluid and pharmacological management.
{"title":"Spinal anaesthesia with intravenous sedation for total hip arthroplasty in two patients with a history of orthotopic heart transplantation","authors":"L. Tseng, I. Al-Saidi, V. Channagiri","doi":"10.1002/anr3.12263","DOIUrl":"https://doi.org/10.1002/anr3.12263","url":null,"abstract":"<div>\u0000 \u0000 <p>Many patients with orthotopic heart transplantation later undergo non-cardiac surgery. Historically, neuraxial anaesthesia has been avoided in these patients because the denervated heart is unable to compensate for hypotension via the baroreceptor reflex. Here, we present the cases of two patients with prior heart transplantation who underwent total hip arthroplasty under spinal anaesthesia with intravenous sedation. In both cases, this technique was well-tolerated haemodynamically. We propose that spinal anaesthesia with intravenous sedation can be a safe and efficacious anaesthetic technique for selected patients with a history of orthotopic heart transplantation, with careful intraoperative fluid and pharmacological management.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"11 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138449404","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}
<p>A 71-year-old man was admitted to the Cardiothoracic Intensive Care Unit following implantation of a left ventricular assist device (LVAD) (Impella, Abiomed, Danvers, MA, USA) and percutaneous coronary intervention (PCI) procedure. His medical history included coronary artery disease and end-stage chronic kidney disease requiring haemodialysis via an arteriovenous (AV) fistula on his right arm. He was transferred to our centre with new onset heart failure and was found to have a left ventricular ejection fraction of 22% on transthoracic echo. Percutaneous coronary intervention was deemed too high risk to undertake without LVAD support. During a protracted recovery, on day 46, he required a replacement central venous catheter (CVC) and dialysis catheter. The left internal jugular vein was chosen due to the presence of existing vascular access devices elsewhere. An 8.5 Fr, 20 cm quad-lumen CVC (Multicath 4expert, Vygon, Aachen, Germany) and a 13.5 Fr, 20 cm dual lumen dialysis catheter (Hemo-cath, Nikkiso Co Ltd, Tokyo, Japan) were sited at a depth of 18 cm and 17 cm respectively, with the dialysis catheter placed proximally.</p><p>Blood gas analysis from the distal lumen of the new CVC showed a pO<sub>2</sub> of 10.8 kPa (F<sub>I</sub>O<sub>2</sub> of 0.28). A contemporaneous arterial line sample indicated an arterial pO<sub>2</sub> of 10.5 kPa. A sample from the distal lumen of the dialysis catheter indicated a more reassuring pO<sub>2</sub> of 4.24 kPa. Repeat CVC samples showed a pO<sub>2</sub> of 10 kPa from the distal lumen whilst samples taken from proximal CVC lumens indicated a pO<sub>2</sub> of 4.62 kPa, consistent with venous results. Because of these results, we were concerned that the CVC had punctured the left carotid artery. Neither line was transduced at this stage and a computed tomography (CT) angiogram was arranged urgently, which confirmed an appropriate position for both lines (Fig. 1).</p><p>This case highlights the difficulty of interpreting blood gas samples taken from a CVC in a patient with an AV fistula. The presence of a high pO<sub>2</sub> cannot be interpreted accurately because of abnormal flow of arterial blood from the fistula. However, results compatible with venous samples were taken from the proximal lumens of the CVC which complicated the interpretation of results. Although rare, cases of patients with AV fistulae in whom CVC location is unclear due to unexpected blood gas analysis data have been previously reported [<span>1, 2</span>]. It is well established that the central veins demonstrate laminar flow and that laminae vary in their oxygenation, indicating that mixing of content between the laminae does not necessarily occur [<span>3</span>]. It seems most likely in our case that the distal CVC lumen was situated sufficiently close to the fistula to allow aspiration from an arterial, well-oxygenated stream of blood.</p><p>As per Association of Anaesthetists guidance [<span>4</span>], pressure transduction
{"title":"Challenges in confirming the position of a central venous catheter in the presence of an arterio-venous haemodialysis fistula","authors":"C. R. Evans, T. M. Hall","doi":"10.1002/anr3.12264","DOIUrl":"https://doi.org/10.1002/anr3.12264","url":null,"abstract":"<p>A 71-year-old man was admitted to the Cardiothoracic Intensive Care Unit following implantation of a left ventricular assist device (LVAD) (Impella, Abiomed, Danvers, MA, USA) and percutaneous coronary intervention (PCI) procedure. His medical history included coronary artery disease and end-stage chronic kidney disease requiring haemodialysis via an arteriovenous (AV) fistula on his right arm. He was transferred to our centre with new onset heart failure and was found to have a left ventricular ejection fraction of 22% on transthoracic echo. Percutaneous coronary intervention was deemed too high risk to undertake without LVAD support. During a protracted recovery, on day 46, he required a replacement central venous catheter (CVC) and dialysis catheter. The left internal jugular vein was chosen due to the presence of existing vascular access devices elsewhere. An 8.5 Fr, 20 cm quad-lumen CVC (Multicath 4expert, Vygon, Aachen, Germany) and a 13.5 Fr, 20 cm dual lumen dialysis catheter (Hemo-cath, Nikkiso Co Ltd, Tokyo, Japan) were sited at a depth of 18 cm and 17 cm respectively, with the dialysis catheter placed proximally.</p><p>Blood gas analysis from the distal lumen of the new CVC showed a pO<sub>2</sub> of 10.8 kPa (F<sub>I</sub>O<sub>2</sub> of 0.28). A contemporaneous arterial line sample indicated an arterial pO<sub>2</sub> of 10.5 kPa. A sample from the distal lumen of the dialysis catheter indicated a more reassuring pO<sub>2</sub> of 4.24 kPa. Repeat CVC samples showed a pO<sub>2</sub> of 10 kPa from the distal lumen whilst samples taken from proximal CVC lumens indicated a pO<sub>2</sub> of 4.62 kPa, consistent with venous results. Because of these results, we were concerned that the CVC had punctured the left carotid artery. Neither line was transduced at this stage and a computed tomography (CT) angiogram was arranged urgently, which confirmed an appropriate position for both lines (Fig. 1).</p><p>This case highlights the difficulty of interpreting blood gas samples taken from a CVC in a patient with an AV fistula. The presence of a high pO<sub>2</sub> cannot be interpreted accurately because of abnormal flow of arterial blood from the fistula. However, results compatible with venous samples were taken from the proximal lumens of the CVC which complicated the interpretation of results. Although rare, cases of patients with AV fistulae in whom CVC location is unclear due to unexpected blood gas analysis data have been previously reported [<span>1, 2</span>]. It is well established that the central veins demonstrate laminar flow and that laminae vary in their oxygenation, indicating that mixing of content between the laminae does not necessarily occur [<span>3</span>]. It seems most likely in our case that the distal CVC lumen was situated sufficiently close to the fistula to allow aspiration from an arterial, well-oxygenated stream of blood.</p><p>As per Association of Anaesthetists guidance [<span>4</span>], pressure transduction","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"11 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.12264","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138449403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Farkas, A.-C. Aeberhard, E. Schiffer, S. J. Brull, C. Czarnetzki, J. Maillard
<p>Sugammadex is a selective neuromuscular blocking agent (NMBA) binding drug which reverses neuromuscular block induced by aminosteroid non-depolarising NMBAs. It contains a gamma-cyclodextrin structure with a hydrophilic internal cavity into which aminosteroid NMBAs are bound with high affinity, thereby inactivating them (Fig. 1) [<span>1</span>]. However, sugammadex can also bind to other molecules [<span>2</span>]. Here, we report a failure of sugammadex antagonism of neuromuscular block with rocuronium in a patient who was taking exogenous steroid hormones.</p><p>A 60-year-old man, scheduled for a robot-assisted nephrectomy, disclosed an ongoing use of steroids related to his bodybuilding practice. Self-medication included testosterone (750–1000 mg per week intramuscularly) and trestolone acetate (300 mg per week intramuscularly). Trestolone acetate is a selective androgen receptor modulator and a nandrolone derivative, 10 times more potent than testosterone (Fig. 1). Preoperative testing revealed a free testosterone blood level of 5540 pmol.l<sup>−1</sup> (reference value, 170–660 pmol.l<sup>−1</sup>) and total testosterone (sex hormone binding globulin, SHBG) of 134 nmol.l<sup>−1</sup> (reference value, 6.1–27.1 nmol.l<sup>−1</sup>). The patient weighed 102 kg and was 180 cm tall, with normal renal function.</p><p>Routine general anaesthesia was provided for the robotic surgery, with a total rocuronium dose of 139 mg intravenously (60 mg at induction followed by infusion of 0.2 mg.kg<sup>−1</sup>.h<sup>−1</sup>). The baseline train-of-four ratio (TOFr) measured with acceleromyography (Philips IntelliVue NMT, Philips, Amsterdam, The Netherlands) before rocuronium administration was 100%. At the end of surgery, TOFr was 33%, requiring administration of 2 mg.kg<sup>−1</sup> sugammadex. Ten minutes after administration of sugammadex 200 mg intravenously the TOFr had increased to 48%. After five more minutes, TOFr reached 52%. Due to this unusually slow reversal, an interaction between sugammadex and steroid hormones was suspected, and we supplemented the neuromuscular block antagonism with intravenous neostigmine 2.5 mg and glycopyrrolate 0.5 mg. Within 45 seconds of neostigmine administration, TOFr recovered to 100%.</p><p>This case describes what might be a faster-than-expected antagonistic effect of neostigmine; however, the onset of action of neostigmine administered at a recovery TOFr of 21% can be as quick as 40 sec [<span>3</span>]. This was consistent with our observations, particularly since neostigmine was given after sugammadex-induced recovery had already started. Our case suggests the potential for pharmacological interactions that may reduce the efficacy of sugammadex in antagonising aminosteroid NMBAs. Anabolic steroids, such as testosterone or trestolone acetate, used to increase muscle mass, are increasingly popular. It is possible that these drugs or their metabolites, which share some of the structural properties of aminoste
{"title":"Potential interaction between exogenous anabolic steroids and sugammadex: failed reversal of rocuronium in a patient taking testosterone and trestolone acetate","authors":"K. Farkas, A.-C. Aeberhard, E. Schiffer, S. J. Brull, C. Czarnetzki, J. Maillard","doi":"10.1002/anr3.12262","DOIUrl":"https://doi.org/10.1002/anr3.12262","url":null,"abstract":"<p>Sugammadex is a selective neuromuscular blocking agent (NMBA) binding drug which reverses neuromuscular block induced by aminosteroid non-depolarising NMBAs. It contains a gamma-cyclodextrin structure with a hydrophilic internal cavity into which aminosteroid NMBAs are bound with high affinity, thereby inactivating them (Fig. 1) [<span>1</span>]. However, sugammadex can also bind to other molecules [<span>2</span>]. Here, we report a failure of sugammadex antagonism of neuromuscular block with rocuronium in a patient who was taking exogenous steroid hormones.</p><p>A 60-year-old man, scheduled for a robot-assisted nephrectomy, disclosed an ongoing use of steroids related to his bodybuilding practice. Self-medication included testosterone (750–1000 mg per week intramuscularly) and trestolone acetate (300 mg per week intramuscularly). Trestolone acetate is a selective androgen receptor modulator and a nandrolone derivative, 10 times more potent than testosterone (Fig. 1). Preoperative testing revealed a free testosterone blood level of 5540 pmol.l<sup>−1</sup> (reference value, 170–660 pmol.l<sup>−1</sup>) and total testosterone (sex hormone binding globulin, SHBG) of 134 nmol.l<sup>−1</sup> (reference value, 6.1–27.1 nmol.l<sup>−1</sup>). The patient weighed 102 kg and was 180 cm tall, with normal renal function.</p><p>Routine general anaesthesia was provided for the robotic surgery, with a total rocuronium dose of 139 mg intravenously (60 mg at induction followed by infusion of 0.2 mg.kg<sup>−1</sup>.h<sup>−1</sup>). The baseline train-of-four ratio (TOFr) measured with acceleromyography (Philips IntelliVue NMT, Philips, Amsterdam, The Netherlands) before rocuronium administration was 100%. At the end of surgery, TOFr was 33%, requiring administration of 2 mg.kg<sup>−1</sup> sugammadex. Ten minutes after administration of sugammadex 200 mg intravenously the TOFr had increased to 48%. After five more minutes, TOFr reached 52%. Due to this unusually slow reversal, an interaction between sugammadex and steroid hormones was suspected, and we supplemented the neuromuscular block antagonism with intravenous neostigmine 2.5 mg and glycopyrrolate 0.5 mg. Within 45 seconds of neostigmine administration, TOFr recovered to 100%.</p><p>This case describes what might be a faster-than-expected antagonistic effect of neostigmine; however, the onset of action of neostigmine administered at a recovery TOFr of 21% can be as quick as 40 sec [<span>3</span>]. This was consistent with our observations, particularly since neostigmine was given after sugammadex-induced recovery had already started. Our case suggests the potential for pharmacological interactions that may reduce the efficacy of sugammadex in antagonising aminosteroid NMBAs. Anabolic steroids, such as testosterone or trestolone acetate, used to increase muscle mass, are increasingly popular. It is possible that these drugs or their metabolites, which share some of the structural properties of aminoste","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"11 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.12262","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138439806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Left main bronchus completely occluded by tumour fragment following right pneumonectomy","authors":"V. Panwar, N. Gupta, S. K. Bhoriwal","doi":"10.1002/anr3.12261","DOIUrl":"https://doi.org/10.1002/anr3.12261","url":null,"abstract":"","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"11 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138439807","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}
Ondansetron is a highly selective 5-hydroxytryptamine receptor antagonist and the most commonly used anti-emetic for the prevention of postoperative nausea and vomiting. Ondansetron has a low affinity for dopamine receptors and so extrapyramidal side effects are rare. Here, we present the case of a 14-year-old girl who developed a severe post-operative acute dystonic reaction which included oculogyric crisis. We believe that ondansetron was the most likely cause, although propofol may have been a synergistic or alternative causative agent. The patient had no significant past medical history and had previously undergone two uneventful general anaesthetics which included both ondansetron and propofol. The prolonged duration and severity of the reaction and failure to fully respond to specific treatments resulted in the need for tracheal intubation and transfer to a paediatric intensive care unit. She subsequently recovered uneventfully with no ongoing neurological sequalae. Ondansetron-induced dystonic reactions are rare and unpredictable and can occur in patients who have previously received the drug without complication. They are thought to be caused by an imbalance between inhibitory and excitatory neurotransmitters in the extrapyramidal system. Specific treatments include anticholinergics, antihistamines and benzodiazepines.
{"title":"Severe acute drug-induced dystonia in the post-operative period requiring tracheal re-intubation","authors":"A. V. Baigent, E. A. J. Morris","doi":"10.1002/anr3.12258","DOIUrl":"https://doi.org/10.1002/anr3.12258","url":null,"abstract":"<div>\u0000 \u0000 <p>Ondansetron is a highly selective 5-hydroxytryptamine receptor antagonist and the most commonly used anti-emetic for the prevention of postoperative nausea and vomiting. Ondansetron has a low affinity for dopamine receptors and so extrapyramidal side effects are rare. Here, we present the case of a 14-year-old girl who developed a severe post-operative acute dystonic reaction which included oculogyric crisis. We believe that ondansetron was the most likely cause, although propofol may have been a synergistic or alternative causative agent. The patient had no significant past medical history and had previously undergone two uneventful general anaesthetics which included both ondansetron and propofol. The prolonged duration and severity of the reaction and failure to fully respond to specific treatments resulted in the need for tracheal intubation and transfer to a paediatric intensive care unit. She subsequently recovered uneventfully with no ongoing neurological sequalae. Ondansetron-induced dystonic reactions are rare and unpredictable and can occur in patients who have previously received the drug without complication. They are thought to be caused by an imbalance between inhibitory and excitatory neurotransmitters in the extrapyramidal system. Specific treatments include anticholinergics, antihistamines and benzodiazepines.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"11 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"109169663","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}
A 45-year-old man attended to a warehouse fire involving burning plastic, without wearing full protective equipment. He subsequently presented to hospital with shortness of breath and his trachea was intubated for airway protection due to initial concerns of inhalational injury. However, a post-intubation bronchoscopy was normal. The patient's serum lactate level was normal on admission but was increased when measured 14 h after the initial event and accompanied by a metabolic acidosis. Transdermal cyanide poisoning was suspected given this delayed biochemical presentation and the absence of another apparent cause. A handheld chemical detector detected a high level of toxins on the patient's skin. Clinical improvement was not observed after the first dose of intravenous hydroxocobalamin, which was administered before full body decontamination. After decontamination and the administration of a second dose of hydroxocobalamin, the patient's acid–base status rapidly improved and serum lactate level returned to normal. Clinicians should have a high index of suspicion for transdermal cyanide poisoning in patients presenting after exposure to a fire.
{"title":"Delayed presentation of transdermal cyanide poisoning","authors":"J. W. L. Lim, C. Kwa, S. Loh, W. S. Yew","doi":"10.1002/anr3.12254","DOIUrl":"10.1002/anr3.12254","url":null,"abstract":"<div>\u0000 \u0000 <p>A 45-year-old man attended to a warehouse fire involving burning plastic, without wearing full protective equipment. He subsequently presented to hospital with shortness of breath and his trachea was intubated for airway protection due to initial concerns of inhalational injury. However, a post-intubation bronchoscopy was normal. The patient's serum lactate level was normal on admission but was increased when measured 14 h after the initial event and accompanied by a metabolic acidosis. Transdermal cyanide poisoning was suspected given this delayed biochemical presentation and the absence of another apparent cause. A handheld chemical detector detected a high level of toxins on the patient's skin. Clinical improvement was not observed after the first dose of intravenous hydroxocobalamin, which was administered before full body decontamination. After decontamination and the administration of a second dose of hydroxocobalamin, the patient's acid–base status rapidly improved and serum lactate level returned to normal. Clinicians should have a high index of suspicion for transdermal cyanide poisoning in patients presenting after exposure to a fire.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"11 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71489533","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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