Krogsgaardpetersson8822

An 80-year-old lady suffered loss of cardiac output during an elective pacemaker lead exchange. Right ventricular perforation, cardiac tamponade, vascular lacerations and circulatory shock are known major complications of pacemaker lead exchange and may necessitate aggressive resuscitation. An emergency sternotomy revealed the administered fluid, blood products and resuscitative drugs, which were administered through an upper limb cannula, had likely extravasated at the site of an iatrogenic injury to the superior vena cava. Unfortunately, further resuscitation attempts were unsuccessful. There are no recommendations regarding sites for intravascular access during pacemaker lead exchange and we argue that lower limb veins should be considered for venous access, as the superior vena cava and innominate veins are possible sites of unintentional vascular injury. Mitoubiquinone price © 2019 Association of Anaesthetists.Topical application of skin-lightening cream is increasingly undertaken in many non-Caucasian populations for cultural and social reasons. It is a rare cause of poisoning that has potential to lead to significant harm due to skin damage and systemic absorption of cream following application over prolonged periods of time. This case report describes for the development of multi-organ failure in an adult due to salicylate toxicity after whole-body application of a skin-lightening cream for 24 h. It highlights the need for vigilance and awareness of the toxic potential of topical salicylates. © 2019 Association of Anaesthetists.A 44-year-old previously healthy woman underwent surgery of the vocal folds and developed early postoperative seizures caused by an unusual aetiology. Clinical assessment and laboratory results revealed that the patient suffered from an acute-onset shigellosis infection which was thought to be the cause of her early postoperative seizures. The shigellosis infection was treated with azithromycin which resulted in rapid clinical improvement, and the seizures were successfully managed with benzodiazepines, sodium valproate and levetiracetam. To our knowledge, this is the first reported case of shigellosis-induced seizures in an adult in the peri-operative period. Early detection of the aetiology of seizures is crucial to ensure appropriate management and a safe patient outcome. © 2019 Association of Anaesthetists.A 64-year-old man sustained blunt trauma to the anterior neck following a mechanical fall resulting in an isolated laryngeal fracture of the left cricoarytenoid complex. Although there was no acute airway compromise, he developed worsening airway oedema which necessitated tracheal intubation. He underwent oral awake tracheal intubation with a flexible bronchoscope to facilitate formation of a tracheostomy under general anaesthesia. The challenges encountered in the clinical management of this case relate to decision making for the patient with airway trauma in the absence of the need for emergency tracheal intubation. We describe the advantages and pitfalls of various airway management strategies in the context of blunt airway trauma. © 2019 Association of Anaesthetists.We describe the use of high-flow nasal oxygen for an obese patient with obstructive sleep apnoea presenting for revision of a spinal cord stimulator. The use of high-flow nasal oxygen allowed the delivery of a high inspired oxygen concentration with humidification and improved patient comfort compared with our usual choice of device, the Hudson mask. It also provided continuous positive airways pressure which is likely to have reduced pharyngeal collapse and atelectasis. The use of high-flow nasal oxygen enabled the delivery and careful titration of deep sedation with propofol and remifentanil, to allow a successful revision procedure to take place without airway complications or significant oxygen desaturation in a high-risk patient in the prone position. © 2019 Association of Anaesthetists.A 28-year-old woman presented for excision of a left-sided pleuropulmonary sarcoma which was adherent to her left subclavian artery and mediastinum. A left upper lobe wedge resection was performed via a median sternotomy and a left carotid artery-to-left subclavian artery bypass was performed through a left supraclavicular incision. We report on a triple regional anaesthesia technique to provide postoperative analgesia. We inserted bilateral transverse thoracic plane catheters for continuous local anaesthetic infusion and performed bilateral subcostal transversus abdominus plane blocks for drain site analgesia. A left superficial cervical plexus block was performed to cover pain from the supraclavicular incision. Anteromedial chest wall blocks are an emerging analgesic technique for sternotomy and were successfully used as part of a combined regional anaesthetic for a patient undergoing complex thoracic surgery. © 2019 Association of Anaesthetists.We report on the novel and successful use of local anaesthetic wound infusions via elastomeric pumps in a 17-year-old male who underwent emergent clamshell thoracotomy after sustaining a stab wound to the flank. This formed one component of a multi-modal analgesic regimen aimed at reducing opioid requirements and their associated side-effects. The patient was mobilising and was discharged from the intensive care unit 24 h postoperatively. There was an unplanned break in the local anaesthetic infusion during which the patient's reported pain scores increased significantly. The catheters were removed on the fifth postoperative day and he was discharged from hospital on day 7. © 2019 Association of Anaesthetists.We report a case of sudden cardiovascular collapse several weeks following surgical repair of a traumatic diaphragmatic hernia. The patient presented with features of circulatory shock without a clear diagnosis, therefore an urgent computed tomography scan of the chest and abdomen was undertaken, which revealed a pericardial effusion with evidence of cardiac tamponade. Ultrasound-guided needle pericardiocentesis with aspiration of blood from the pericardial sac in the Emergency Department provided an immediate response and her cardiac output improved. On review of the imaging, it is likely a surgically-placed permanent metallic fixation device, sitting near the pericardium, caused bleeding into the pericardial sac due to local trauma as a delayed postoperative complication. © 2019 Association of Anaesthetists.