Αναφορές Περιπτώσεων

The number of pregnant women with morbid obesity (BMI 40–49.9 kg/m2) has significantly increased worldwide. Management of these patients presents a challenge for obstetric anesthesiologist. We report our management of cesarean delivery in a parturient with a BMI 47.3 kg/m2. We present this case to emphasize usefulness of Tuohy needle as an introducer for performing spinal anesthesia with a long 27G pencil point needle. Literature review is discussed. Continue reading
Hemophagocytic Lymphohistiocytosis (HLH) is a life-threatening syndrome of excessive immune activation that mostly occurs as primary (hereditary) disease in children. Acquired HLH is associated with infections, cancer of rheumatological conditions. Both are rare in adults. Turicella otitidis is a bacterium, that is associated with ear infections and there is only one case report of bacteraemia. The present report describes a case of acquired HLH with invasive pulmonary Aspergillosis and Turicella otitidis bacteraemia in an adult patient; and also reviews the relative literature. In conclusion though rare, acquired HLH is a devastating condition that clinicians should have in mind when managing patients with multiple infection or underlying immunosuppression. Continue reading
Acute uvular edema is a rare complication that can be presented in the postoperative period, usually after general anesthesia. If severe enough, it can even result in a compromised airway. In this case report, we present a case of postoperative acute uvular edema occurred in an orthopedic patient, after spinal anesthesia and infraclavicular brachial plexus nerve block combined with intravenous sedation. Continue reading
Pneumothorax is a collection of air in the pleural space between the lungs and the chest wall and depending on its cause it could be either spontaneous or traumatic. Tension Pneumothorax (TPT) can be a cause of cardiac arrest (CA) or might be a complication after chest compressions. According to the 2015 European Resuscitation Council guidelines on resuscitation, TP is considered one of the reversible causes of CA, which should be recognized and treated during cardiopulmonary resuscitation (CPR).   Continue reading
Ο ιός του Δυτικού Νείλου (WNV) απομονώθηκε για πρώτη φορά το 1937 σε μια γυναίκα της Βόρειας Ουγκάντας, αλλά τα τελευταία χρόνια υπάρχει αυξημένο ενδιαφέρον καθώς οφείλεται για επιδημίες σε διάφορα μέρη του κόσμου (1996 στη Ρουμανία, 1999 στις Η.Π.Α , κ.α.)1. Ο WNVείναι RNA ιός της οικογένειας των φλαβοϊών (flavivirus) και ανήκει στην αντιγονική ομάδα των ιών της Ιαπωνικής εγκεφαλίτιδας. Η κύρια φυσική δεξαμενή είναι τα πτηνά, ενώ κύριοι ενδιάμεσοι ξενιστές και μεταδότες είναι τα κουνούπια του γένους Culexι2. Continue reading
Mitochondrial diseases represent a wide range of disorders caused by impairment of mitochondrial metabolism and energy production. We report a case of an uneventful perioperative management of a pregnant patient with early childhood-onset mitochondrial encephalopathy, attributed to a novel AIFM1 (Apoptosis-Inducing Factor, Mitochondrion-associated 1) mutation. After a multidisciplinary team consultation, it was decided to be posted for elective caesarean delivery at 36+2 weeks of gestation, under titrated combined spinal-epidural anaesthesia and multimodal analgesia. Unique anaesthetic challenges were to ensure normoglycaemia, normothermia and adequate hydration while avoiding perioperative stress and acidosis. Continue reading
Intravesical bacillus Calmette-Guerin (BCG) therapy, recommended for superficial bladder tumors, triggers side effects in fewer than 5% of patients. Yet, when encountered, high level of suspition and early detection is essential for their succesfull management. In the present article, we present a case of severe sepsis and Steven Johnson syndrome in a male patient after intravesical BCG instillation. Intravesical instillation of Bacillus Calmette-Guérin (BCG) is frequently used as the treatment of choice for carcinoma in situ and non-invasive high-grade superficial tumor of the urinary bladder1. BCG is a live attenuated strain of Mycobacterium bovis and is the most widely used intravesical agent2. Adverse events occur in fewer than 5 % of cases, ranging from mild local symptoms to severe sepsis and death1-3. In the present article, we report a case of successful management of septic shock with concomitant Steven Johnson syndrome after intravesical BCG instillation and perform a short review of the relevant literature. Continue reading
Pericardial decompression syndrome (PDS) is a rare but eventually fatal syndrome, which occurs after pericardial drainage. In this report we describe a patient who suffered from cardiovascular collapse and pulmonary edema after pericardial drainage. A male patient aged 42yrs complained of progressive dyspnea over the past 2 months and presented with clinical signs of pericardial tamponade. The patient underwent a surgical subxiphoid pericardial drainage under general anesthesia and mechanical ventilation. After pericardial drainage of 2.2lt, the patient was transferred to the Intensive Care Unit, where he was extubated2 hours later. Immediately after extubation, he showed clinical signs of cardiovascular collapse and pulmonary edema. The patient was reintubated immediately and placed on mechanical ventilation. He was extubated after 12hrs. His postoperative course was uneventful and he was discharged from the hospital after a few days. Continue reading
Anaesthetic management of patients with comorbidities can be challenging and requires rigorous planning. Peripheral nerve blocks (PNBs) do not compromise haemodynamics or pulmonary function. We present the management of a patient with symptomatic syringomyelia, severe pulmonary hypertension, thrombophilia and obstructive sleep apnoea undergoing hip fixation. Combined psoas compartment and sciatic nerve block was conducted and the patient remained stable perioperatively. She had an uneventful recovery and was discharged three days later. Patients with multiple comorbidities are subject to high perioperative risk and should be managed individually. Regional anaesthesia can be a last resort that leads to a better outcome. Continue reading
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