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Query: UMLS:C0278134 (anesthesia)
 110,339 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report resistance to vecuronium bromide (Vb) induced muscle relaxation for general anesthesia in a patient with chronic renal failure (CRF) and secondary hyperparathyroidism (HPT). An 81-year-old man (body weight : 52 kg) diagnosed with bladder carcinoma was scheduled for a total cystectomy. In the operating room, standard monitors were applied except for a nerve stimulator. After epidural catheter had been secured, anesthesia was induced with propofol 80 mg and Vb 5 mg. In spite of administration of these drugs and supplying 5% sevoflurane for 4 minutes, spontaneous respiration was observed. Then, propofol 50 mg and Vb 3 mg were added and lidocaine aerosol 8% was sprayed topically to oropharyngolaryngeal structures. No movement of the vocal cord was observed through the laryngoscope and the patient was intubated smoothly, but the patient did cough and move a little. The surgery was concluded uneventfully. Although the total amount of Vb administration was 14 mg in 3 hr anesthesia time, he was awake rapidly and extubated sooner than expected. We suspect that resistance to Vb has been caused in part by secondary HPT and it appears necessary to take care when administering Vb in CRF patients with secondary HPT, especially at the induction of general anesthesia.
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PMID:[Resistance to vecuronium bromide induced muscle relaxation in a patient with chronic renal failure and secondary hyperparathyroidism]. 1787 55

Patients with mitochondrial disease are at risk of metabolic decompensation and often require general anaesthesia (GA) as part of their diagnostic work up and subsequent management. However, the evidence base for the use of GA is limited and inconclusive. We have documented the practice and outcome in the use of GA in paediatric patients with mitochondrial disease using a retrospective case review study of 38 mitochondrial patients who had undergone 58 anaesthetics within the regional metabolic service for the period 1989-2005. A variety of anaesthetic agents were used and the pattern of use reflects that seen in standard paediatric practice. There were no episodes of malignant hyperthermia and no documented intraoperative events attributable to the GA. Three postoperative adverse events were noted; one episode of hypovolaemia, one episode of acute on chronic renal failure, and one episode of metabolic decompensation 12 h post-muscle biopsy. Despite theoretical concern about this group of patients, adverse events after GA are rare and in most cases unrelated to the anaesthesia. Further prospective studies of GA in mitochondrial disease are required to create evidence-based clinical guidelines for safe practice.
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PMID:Mitochondrial disorders and general anaesthesia: a case series and review. 1828 93

Spinal hematoma is an infrequently described complication of spinal anaesthesia. It has been described in the literature in patients with a deranged coagulation profile in the form of systemic diseases (e.g. chronic renal failure, liver failure) or anticoagulant therapy. Whatever the reason, it will have disastrous consequences in the form of permanent paraplegia or persistent neurological deficit if not treated promptly. One therefore needs to maintain a high index of suspicion at all times in any patient who has undergone spinal anesthesia and who exhibits any sign or symptom of a neuraxial hematoma We report a case of post-spinal puncture subdural hematoma in an otherwise healthy male without any predisposing factor.
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PMID:Spinal subdural hematoma: a rare complication of spinal anesthesia: a case report. 1881 28

We report here a case of Staphylococcus epidermidis endocarditis with bacterial vegetation which was suspected by intraoperative alternating pulse on arterial pressure monitoring. A 65-year-old man was diagnosed as lumbar spinal canal stenosis and scheduled for operation. Preoperatively, he had chronic renal failure, mild aortic valve stenosis, and moderate mitral valve regurgitation. Neither inflammatory signs nor vegetations on TEE were observed preoperatively. General anesthesia was induced with propofol and vecuronium, and maintained with oxygen (33%), nitrous oxide and sevoflurane. Two hours after the beginning of operation, alternating pulse was observed suddenly on arterial pressure waves without marked change in hemodynamic parameters. The operation was performed uneventfully and alternating pulse disappeared after changing from prone position to supine. Using a transesophageal echocardiography, large-sized bacterial vegetation (22 x 17 mm) was found in the left ventricle. Second operation was performed to remove vegetation at three weeks after first operation. Alternating pulse is generally considered as a sign of severe left ventricular dysfunction such as dilated cardiomyopathy and aortic stenosis. Therefore, we should be careful about pulse disorder during operation for the patient who is in the state of severe heart failure.
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PMID:[Case of Staphylococcus epidermidis endocarditis with a bacterial vegetation suspected by intraoperative alternating pulse]. 1910 98

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disease characterized by progressive neurological distress and motor weakness in the legs and arms. We report a patient with CIDP who underwent thoracoscopic surgery under general anesthesia. A 43-year-old man was hospitalized for examination of unidentified fever, and PET detected accumulations in the inguinal and mediastinal lymph nodes. The inguinal lymph node biopsy could not reveal the cause, and he was scheduled for thoracoscopic mediastinal lymph node biopsy. He had been diagnosed CIDP by lower motor weakness and sensory disorder for five months, and underwent peritoneal dialysis for chronic renal failure over the past nine months. Anesthesia was induced with propofol, remifentanil, and high-dose sevoflurane. He could be intubated easily with a left-sided Broncho-Cath double-lumen tube with no muscle relaxants. Anesthesia was maintained by sevoflurane (1.5-1.7%) and remifentanil (0.10-0.15 microg x kg(-1) x min(-1)). After the operation, spontaneous respiration appeared immediately after discontinuing anesthetics. Endotracheal tube was removed because of the following data; Sp(O2), 99%; tidal volume, about 600 ml; respiratory rate, 12-15 min(-1); level of consciousness was good. Arterial blood gas determination at this time revealed pH, 7.418: Pa(CO2), 36.0 mmHg : Pa(O2), 329.3 mmHg under 8 l x min(-1) oxygen. The patient showed an uncomplicated postoperative course.
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PMID:[Anesthetic case report of a patient with chronic inflammatory demyelinating polyneuropathy]. 1936 5

We report two cases of postoperative iatrogenic tetraparesis, which occurred in different hospitals after surgery for parathyroidectomy. Both patients were on long-term haemodialysis. The prolonged neck extension usually required by this procedure was probably the main factor involved in the genesis of the spinal cord injury. Spinal abnormalities associated with chronic renal failure may have made these patients more vulnerable. In our opinion, it is advisable to investigate thoroughly any sign of spinal stenosis in patients who undergo any procedure requiring significant neck extension, particularly if on long-term haemodialysis.
Anaesthesia 2009 Sep
PMID:Tetraplegia following parathyroidectomy in two long-term haemodialysis patients. 1968 87

Surgery in a chronic renal failure patient carries a substantial higher risk then in normal renal function individuals. This is due to more frequent bleeding and infectious complications, intravascular volume impairments, side effects of anesthesia and others. Development of dialysis technique increased the number of patients receiving treatment for end stage renal disease; their prolonged survival rates, as well as the high percentage of co-morbid conditions will continuously raise the need for surgery in patients with chronic renal failure. The complex and difficult management of these patients requires close cooperation of intensive care specialists and nephrologists, in order to reconcile their frequently opposing views.
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PMID:[Management of the chronic renal patient undergoing surgery]. 1994 50

A 61-year-old woman with chronic renal failure (CRF) associated with Alport syndrome underwent coronary artery aneurysmectomy under general anesthesia. Hemorrhage control was difficult during the surgery, and she became hemodynamically unstable. The surgery and anesthesia lasted 446 and 552 min, respectively. On postoperative day 1, she developed severe respiratory distress several minutes after extubation. Her trachea was immediately reintubated. The second attempt to extubate her trachea also failed. Fiberoptic examination revealed bilateral vocal cord paralysis (VCP) due to recurrent laryngeal nerve (RLN) paralysis. Although she needed a temporary tracheostomy, vocal cord movement recovered without treatment 3 months after surgery. The mechanisms underlying her symptoms may be multifactorial: the first and foremost factor was that she had been receiving maintenance hemodialysis for 20 years since being diagnosed with Alport syndrome. We speculated that RLN vulnerability due to Alport syndrome and CRF strengthened her symptoms. We also recognized that the long-lasting mechanical stress and low perfusion to the RLN due to hemodynamic instability during surgery were indispensable contributory factors to the development of VCP. This is the first report of postoperative bilateral VCP in a patient with CRF related to Alport syndrome. Based on this experience, we strongly recommend preoperative detailed examination of vocal cord function in patients with CRF associated with Alport syndrome.
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PMID:Bilateral vocal cord paralysis in a patient with chronic renal failure associated with Alport syndrome. 2022 44

A 52-year-old woman, undergoing hemodialysis for chronic renal failure over thirty years, developed pheochromocytoma. Her serum concentrations of noradrenaline (NA) and adrenaline were 5,330 pg x ml(-1) and 212 pg x ml(-1), respectively. She had often developed hypertensive crisis and also hypotensive crisis during hemodialysis, and quite often she had to give up continuing hemodialysis before its end. Anesthesia was induced by propofol, remifentanil and maintained with oxygen, air, propofol and remifentanil. Before starting operation, continuous hemodiafiltration (CHDF) was performed without any water removal. Although hypotension occurred temporarily after CHDF, severe hemodynamic changes were not observed during operation owing to NA substitution and infusion of 5% plasma protein fraction, and the operation was finished uneventfully. The molecular weight of NA is 169.18, and it can be filtered by CHDF. Because of removal of excessive NA by CHDF, we can avoid severe hemodynamic changes often observed in other case reports. CHDF was useful for anesthetic management of a patient with adrenal pheochromocytoma.
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PMID:[Anesthetic management for laparoscopic resection of adrenal pheochromocytoma in a woman with chronic renal failure]. 2022 64

Spinal epidural abscesses are uncommon, but potentially devastating and often fatal. They can be found in normal patients, but they are more prevalent in immunocompromised patients, such as intravenous drug users, diabetics, chronic renal failure patients, pregnant women, and others. Timely diagnosis and treatment are the keys to optimizing outcome. Traditionally, treatment has comprised parenteral antibiotics and possible surgical intervention, such as decompression by pus drainage. We treated a long level (T4-L1) epidural abscess in a diabetic patient who had to undergo emergent long level decompression and drainage due to complete paralysis of the lower extremities and progression of neurologic deficit toward the upper thoracic level. Although lower extremity paralysis has not improved, the patient has completely recovered from lower extremity anesthesia. Further follow-up was not done because the patient expired due to sepsis eight month after surgery.
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PMID:Long level (t4-l1) spinal epidural abscess in a diabetic patient - a case report -. 2041 Nov 44


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