Sulprostone, a synthetic prostaglandin with potent uterotonic action, has been shown to have a low complication rate in a large series. We present a case in which a bolus intravenous injection of sulprostone 30 µg was administered to treat postpartum haemorrhage during caesarean section. The 38-year-old patient with no previous cardiac or smoking history developed complete heart block, ventricular fibrillation and subsequent asystole. Cardiopulmonary resuscitation was successful after 45 minutes. Post resuscitation there was no myocardial infarction and she had complete neurological recovery. We postulate that the bolus of sulprostone resulted in possible coronary spasm that resulted in cardiac arrest.
Foucart ( 1875) and Ortncr (1899) were the first to describe pulmonary ocdcina as a complication of drainage of hydrothoraces. Subsequently. others reported a similar complication after the treatment of pneumothoraces.' , L Acute unilateral pulmonary oedema was also described in a case which occurred in the operating room at the end of thoracotomy and pleurodesis for recurrent pneumothorax from a lung cyst..' Our case is the l i n t report in the literature of localised pulmonary oedema which developed immediately after the surgical repair of a ruptured hemidiaphrapi. Case historyA 23-year-old man was admitted to hospital after a road traffic accident. He had multiple bilateral rib fractures with ;I right haemothorax, and a traumatic rupture of the right hcinidiaphragm with herniation of the liver into the pleural caviry which resulted in right lung collapse (Fig. 1). He also sustained fracturcs of the 12th thoracic, Ist, 4th and 5th lumbar vertebrae. which were associated with paraplegia. There was no evidence of head injury.He was resuscitated successfully and the haeniothorax \ q x cv;icuated by B right thoracostomy. Six days later he wiis transferred to our hospital for thoracotorny and rcpair of thc ruptured right hemidiaphragm: these procedures wcre performed 14 days after the iii.jury. The right lung tlui-ing the operation wits found to be about 609' " compressed by thc liver and transverse colon, and requircd manual re-infation with positive pressure ventilation after thc surgical repair of the ruptured diaphragm. The lung looked normal after complete re-expansion with no evidence of contusion. An underwater seal chest drain was inserted postoperatively and w a s allowed to drain passively.The patient's lungs were ventilated electively in the intensive care unit after the operation. His condition deteriorated suddenly less than one hour after operation. He became sweaty, restless. tachypnoeic and hypotcnsive. and copious amounts of slightly blood-stained frothy sputum were aspirated from thc trachea. A chcst X ray (Fig. 3 ) showed pulmonary ocdcnia in the right lowcr and middle lobes. Blood gas analysis showed a pH of 7.2. arterial carbon dioxide tcnsion of 8.3 kPa and arterial oxygen tension of 6.5 kPa with an inspircd oxygen concentralion of 60%. Ventilation improved with positivc end-expiratory pressure (PEEP) of + 1 kPa and muscle paralysis. Central vcnous pressure was 10 cmH20.Fluids were transfused and inotropic support started. Thc ocdcma fluid from the tracheal tube iinmediatel!. turned yellow. the colour of tlic infusatc when 20% albumin was given. Llnfortunately no specimen was obtained for protein analysis. Eight hours later his condition improved markedly; a repeat chest X ray (Fig. 3) showed complete resolution of the pulmonary ocdcnia. Hc continued to make good progress and was subsequently discharged to thc general ward and thence to a rehabilitation unit. DiscussionI'ulmonary oedeina is an abnormal collcction o f fluid in the extravascular tissucs and r p x x s of the lung.4 Fluid exchang...
SummaryThe LMA CTrach TM (CTrach) enables ventilation, glottis visualisation and tracheal intubation via a laryngeal mask conduit. The CTrach has been successfully used in patients with cervical spine pathology, but it is unclear if cervical spine immobilisation affects its ease of use. In this randomised crossover trial, the CTrach was used once with and once without manual in-line stabilisation of the cervical spine in every patient. With manual in-line stabilisation, the median [IQR] time to achieve ventilation was 22 [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The application of manual in-line stabilisation (MILS) in patients with cervical spine injuries can make laryngeal mask airway insertion and tracheal intubation more difficult [1,2]. Using an Intubating Laryngeal Mask Airway (ILMA) (The Laryngeal Mask Company, Singapore) together with a fibreoptic bronchoscope can improve the success rate of tracheal intubation during MILS as compared with using a Macintosh laryngoscope combined with a bougie [3]. The LMA CTrach TM system (The Laryngeal Mask Company) is a further development of the ILMA that incorporates fibreoptic channels in the laryngeal mask conduit, and has a detachable liquid crystal display viewer. It optimises laryngeal mask placement and tracheal intubation under direct vision. Provided the larynx can be fully visualised with the CTrach, the first attempt success rate of tracheal intubation is between 96-100% [4,5]. In a recent comparison, the first attempt success rate was 93% with the CTrach compared with 68% with the ILMA [6].The CTrach has been used successfully in patients with difficult airways due to anatomical variations, limited cervical spine mobility and obesity [7][8][9][10]. Although the CTrach is designed to be used with minimal neck movement, the impact of MILS on its use is presently unclear. In our practice, we had perceived some subjective difficulty in CTrach use when MILS was applied. Therefore we wished to evaluate the impact of MILS on the ease of achieving ventilation and glottis visualisation with the CTrach, in a randomised crossover trial. MethodsWe obtained institutional review board approval and written informed consent from 50 patients, aged 21-80 years, ASA I-III status, who were having elective surgery that required general anaesthesia and tracheal intubation. We excluded patients who had cervical spine
The introduction of transmyocardial laser revascularization for ischaemic heart disease has brought with it new challenges for anaesthetists. These include acute deterioration of cardiac function, the need for emergency cardiopulmonary bypass and difficulty weaning from haemodynamic support. Recurrent arrhythmias can occur despite amiodarone prophylaxis. We describe our initial experience and the problems we encountered.
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