Hepatic cryotherapy is a relatively new technique, currently employed in the treatment of unresectable liver malignancy, which involves direct freezing of tumour deposits with liquid nitrogen. In a review of 26 patients undergoing this procedure, the anaesthetic considerations are defined. The total operation time ranged from 133 to 410 minutes. In spite of preventative measures, varying degrees of hypothermia occurred (range 33.7° C to 36.5° C), but no sequelae were encountered. Mean blood loss was 926 ml, and eleven patients required blood transfusion of between one and five units. There was a marked drop in platelet count associated with cryotherapy (mean fall of 123,000/mm3 by the second postoperative day). Following the procedure, fever and basal pulmonary atelectasis were common, while hypoglycaemia and renal impairment occurred on single occasions. Six patients underwent postoperative mechanical ventilation. Despite this, the mean hospital stay was under seven days.
Blunt trauma to the upper airway is a potentially fatal injury. It is often difficult to diagnose and frequently presents to anaesthetists as an airway emergency. The management of the injury requires careful choice of anaesthetic technique. This choice will be influenced by the expertise of the surgeon and anaesthetist involved and the results of preoperative investigations such as X-rays, CT scans and indirect laryngoscopy. Three cases are presented for discussion, each different in mechanism, site of injury and anaesthetic management. CASE 1 An eighteen-year-old female was brought to the casualty room following a motorcycle accident in which she was thrown onto the road, striking her neck on the kerbside. There was no loss of consciousness. On arrival, she was alert but dyspnoeic. She could speak only in a whisper and loud inspiratory stridor, mild tachypnoea and a tracheal tug were present. There was marked tenderness over the thyroid cartilage and subcutaneous air was palpable bilaterally in the neck. Her blood pressure was normal and chest auscultation was unremarkable. A fractured right tibia and large laceration over the left knee were noted. Bruising and tissue crepitus over the right infra-orbital region suggested facial fractures. Arterial blood gas measurements on room air revealed a P a02 of 66 mmHg and P aco2 of 34
To achieve maximum benefit from a large-bore cannula, a suitably large vein must be chosen. Further, where venous access is difficult and high flow potential from an infusion system is required, two separate infusions through small cannulae may be a preferable option to a single large bore.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.