A new coronavirus (covid 19–coronavirus disease 2019), similar to Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV), emerged in late December 2019 from Wuhan, China causing respiratory disease.
An outbreak of COVID-19 has spread throughout China and worldwide. Up until today (7/4/2020) 1.349.956 confirmed cases and 74.822 deaths were recorded. As of April 7, 2020, 81.740 patients in China had tested positive for COVID-19 and 3.331 deaths had occurred. World Health Organization (WHO) on March 11, 2020 declared COVID-19 a pandemic, pointing the sustained risk of further global spread.The European countries most affected are Spain - 136.675 confirmed cases and 13.341 deaths - and Italy - first European country affected with 132.547 confirmed cases and 16.523 deaths -up until today (7/4/2020).
U.S.A today leads the world in confirmed, reported coronavirus cases, surpassing China with 367.650 confirmed cases and 10.943 deaths. Continue reading →
We have noted an ongoing interest for the anaesthetic practices for caesarean section (CS) throughout Europe, which may differ from one country to the other for several reasons. In a very recent EJA article, a national survey in the Czech Republic and Slovakia has shown that national audits may allow and promote focusing on education and interstate cooperation. Impressively, even if the two countries were united in the past, the rate of general anaesthesia (GA) for CS in the Czech Republic was lowered from 34 to 26% for elective and from 59 to 39% for non-elective CS. This was not the case for the neighboring Slovakia, where the rate for GA was already low. Besides, in a 2017 survey from Austria, the rate of routine use for regional anaesthesia for CS reaches almost 100% and in France has a similar trend. 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 →