Central neuraxial block is associated with increased vagal tone. We report a patient who developed laryngospasm and stridor under spinal anaesthesia. This was treated successfully with i.v. atropine and fluids. We propose that the laryngospasm was secondary to increased vagal tone under the spinal anaesthetic. Such a manifestation of increased vagal tone under spinal anaesthesia has not been reported previously.
SummaryPlacement of a pulmonary artery catheter during cardiac surgery is associated with various complications, one of which is entrapment. On the day following surgery unusual resistance was encountered while attempting to remove a pulmonary artery catheter from a patient who had undergone coronary artery bypass grafting. Entrapment of the catheter was confirmed by transoesophageal echocardiography, which demonstrated invagination of the free wall of the pulmonary trunk on gentle traction on the pulmonary artery catheter. Surgical exploration revealed that the catheter was transfixed by the suture used to close the pulmonary artery vent site. Surgical re-exploration and other potential complications related to catheter retrieval can be avoided if catheter entrapment is diagnosed intra-operatively. We suggest that a high index of clinical suspicion along with the use of intra-operative transoesophageal echocardiography is considered in situations where catheter entrapment is a possibility. The pulmonary artery catheter is commonly used for haemodynamic monitoring of cardiac surgery patients with compromised ventricular function. We report a case of accidental entrapment of a pulmonary artery catheter at the pulmonary artery vent suture site in a patient undergoing coronary artery bypass surgery. Transoesophageal echocardiography was helpful in correctly and promptly diagnosing the underlying problem.
Case reportA 52-year-old male with history of diabetes, triple vessel disease and severe left ventricular dysfunction underwent elective coronary artery bypass surgery. A size 7F pulmonary artery catheter (Edward Life Sciences, Irvine, CA) was inserted without difficulty through a percutaneous sheath introducer (8.5F, Edward Life Sciences) inserted into the right internal jugular vein and a normal pulmonary artery tracing was obtained at 45 cm. A 14F pulmonary artery vent (Romson's plain plastic catheter) was inserted to decompress the heart while the patient was on cardiopulmonary bypass. After uneventful separation from bypass, the pulmonary artery vent was removed and the vent site was closed with 5-0 purse string prolene sutures. Postoperative care was provided in the intensive care unit. The patient was extubated 6 h after surgery. Inotropes were gradually tapered off over the next 24 h and removal of the pulmonary artery catheter was planned prior to transfer to the high dependency unit.On attempting to remove the pulmonary artery catheter unusual resistance was encountered. A chest X-ray revealed that the pulmonary artery catheter was located in the left pulmonary artery with a sharp bend at the highest point in the pulmonary trunk. Transoesophageal echocardiography (Agilent Technologies, Andover, MA) was performed under conscious sedation to determine the cause of the resistance. A mid-oesophageal right ventricular outflow tract view was obtained which showed the pulmonary artery catheter passing through the right ventricle, right ventricle outflow tract and pulmonary trunk. Gentle traction on the pulmonary...
Obstructive Sleep Apnoea is common in children as well. It is strongly associated with parasomnias, including sleep terror, sleep walking etc. In this case report, we are discussing about a boy who was referred to us for the evaluation and management of sleep walking. Enlarged adenoid and tonsil, secondary to allergic disease was found to be causing Obstructive Sleep Apnoea in him, causing a trigger for the sleep walking. Here we are highlighting the importance of controlling the allergic disease in such children, which can even result in the avoidance of invasive surgical interventions like adeno-tonsillectomy.
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