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
Though metformin is considered as first choice drug in type II diabetes, clinicians should be alert both for presence of potential contraindications to its use and to possible adverse reactions. Bad therapy compliance along and/or concomitant comorbidities may lead to serious toxicity. We hereby describe a case of extreme lactic acidosis- associated with metformin therapy- in an elder woman, managed with Continuous Renal Replacement Therapy in Intensive Care Unit environment. Short review of the literature about the place of renal replacement therapy in such cases is also discussed. Continue reading
We present a case report concerning fatal bacteremia caused by Pantoeaagglomerans in a critically ill patient.
Pantoea is a genus of Enterobacteriacae Gram-negative bacteria family that includes at least 20 species; mostly isolated in the ecological niches.
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The case of a 33y old man is presented, who after a car accident, was transferred to the ED with a right hip dislocation and slightly obtunded but in a stable hemodynamic condition. After an emergent CT scan, a thoracic aortic rupture along with intestine rupture and retroperitoneal hematoma were noted. The patient was administered 1 g tranexamic acid (TXA) and 1 g fibrinogen concentrate (FC) preoperatively and then was transferred to the OR, where primarily, under monitored anesthetic care (MAC) the aortic trauma was restored intraluminally and then, under general anesthesia, he underwent laparotomy and hip dislocation reduction. During operation, no diffuse bleeding was noted, nor was any transfusion of blood or blood product necessary. After a short ICU stay the patient was discharged in good general health state. The aim of this case report is to present a case of traumatic aortic rupture bleeding, effectively managed with prophylactic tranexamic acid (TXA) and fibrinogen concentrate (FC) administration without need of any kind of transfusion. Continue reading
Central venous catheters (CVC) are an extremely usefull tool in clinical medicine. Yet, its placement and use is not without complication. In the present paper, a case report of Central venous catheter malposition is presented.
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Η βελτίωση των χειρουργικών τεχνικών αλλά κυρίως των χημειοθεραπευτικών σχημάτων αύξησε κατά πολύ την επιβίωση των ασθενών με κακοήθη νόσο των πνευμόνων. Οι ασθενείς που έχουν υποβληθεί σε θωρακοχειρουργική επέμβαση για κακοήθη νόσο πνευμόνων, έχουν αυξημένη πιθανότητα να υποβληθούν σε μια νέα διαγνωστική ή θεραπευτικήεπέμβαση, λόγω υποτροπής της αρχικής νόσου, ή εμφάνισης ενός δεύτερου πρωτοπαθούς όγκου του πνεύμονα.
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Adamantinomas are rare primary low grade malignant bone tumors’ (<1% of all bone cancers), which are usually located in tibial diaphysis. We present a case of lung metastasis in a 45 year old female who underwent left knee amputation because of tibial adamantinoma.
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The case describes a late presentation of Infantile Hypertophic Pyloric Stenosis in a 5 year old boy, and its management.
Continue readingThymoma is one of the most common tumors of the anterior mediastinum in adults, arising from thymic epithelial cells. Complete surgical resection is the treatment of choice in myasthenic patients with thymoma. A 41 year-old male, with myasthenia gravis and thymoma was scheduled for thymectomy. Ten months ago, he developed pneumonia. He had a history of pneumonia (10 months ago) complicated by severe adult respiratory distress syndrome (ARDS), managed successfully with a short-term support with extracorporeal membrane lung assist device NovaLung. Long-term impairments in lung volume and diffusion capacity have been reported in adult respiratory distress syndrome survivors. Total intravenous anesthesia technique and especially muscle relaxants infusion require special attention in this group of patients. Our management strategies in this case included careful assessment of respiratory function, avoidance of premedication, use of short-acting anesthetic agents (propofol, remifentanil), use of suggamadex for reversal of rocuronium-induced neuromuscular block, and intraoperative monitoring with a train-of-four monitor and monitoring in an intensive care unit for 24 hours after surgery.
Continue readingThis case report focuses on the anesthetic management of a patient with Myasthenia Gravis who underwent left-sided colectomy, due to the presence of a tumor on the left colic (splenic) flexure. Myasthenia gravis is a chronic autoimmune neuromuscular disease which is characterized by differ-ent degrees of weakness of skeletal muscles. The anesthetic management and treatment of every patient with myasthenia gravis should be performed carefully, due to the fact that many periopera-tive complications may occur. In our case anesthetic technique included the combination of general anesthesia, with the use of neuromuscular agent and thoracic epidural blockade with the use of a catheter, which permitted intermittent boluses doses and continuous infusion of local anesthetics and opioids. Neuromuscular blockade was reversed with the use of sugammadex. Patient’s periop-erative management was effective and uneventful.
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