An anaesthesiologist's encounter with purple glove syndrome

Abstract

Purple glove syndrome (PGS) is a devastating complication of intravenous (IV) phenytoin administration. Anaesthetic management during the amputation of the limb for such patients is very challenging due to limited clinical experience. A 65-year-old woman developed PGS of left upper extremity after IV administration of phenytoin following generalised tonic-clonic seizures. The condition progressed rapidly leading to gangrene of left hand extending to the mid arm. Amputation was carried out under general anaesthesia with a supraglottic airway device. We discuss the prevention and alternate managements in PGS, which is a rare clinical entity with limited data in the literature.

Implementation and adherence to a speciality-specific checklist for neurosurgery and its influence on patient safety

“…The implementation of the modified checklist in our study facilitated focussed actions pertinent to patient concerns specific for neurosurgery such as mechanical deep vein thrombosis prophylaxis; use of advanced airway aids for unstable cervical spine;[ 14 ] prevention of hypersensitivity/anaphylaxis to phenytoin;[ 15 ] use of osmotherapy and/or total intravenous anaesthesia (TIVA) for raised ICP; targeted anaesthetic titration for intraoperative neuromonitoring;[ 16 17 ] and point-of-care blood-gas analysis [Tables 3 and 4 ]. This attains further relevance in the context when neurosurgical cases are done by non-neuroanaesthesiologists.…”