Pregnancy and peripartum period leads to Virchow’s triad (hypercoagulability, venous stasis and vascular injury) thereby increasing the risk of thromboembolism by many folds in these patients. Accurate diagnosis of p...Pregnancy and peripartum period leads to Virchow’s triad (hypercoagulability, venous stasis and vascular injury) thereby increasing the risk of thromboembolism by many folds in these patients. Accurate diagnosis of peripartum pulmonary embolism is pertinent for reducing morbidity and mortality. Accurate diagnosis is also vital for avoiding the adverse effects of unwanted anticoagulation in pregnant mother and fetus in a patient wrongly diagnosed with this condition. Computerized tomographic pulmonary angiography has a high specificity and sensitivity in comparison to ventilation/perfusion scan for diagnosis of peripartum pulmonary embolism (PPE). It has a lower fetal radiation exposure and aids in arriving at an alternative diagnosis, if PPE is absent. Low molecular weight heparin is the medication of choice in the treatment of peripartum pulmonary embolism. Thrombolysis is considered in patients with massive PPE and hemodynamic instability, refractory hypoxia or right ventricular dysfunction. Regional anesthesia/analgesia can be given safely in these patients. We report two cases of PPE and review the anesthetic and surgical consideration.展开更多
Endotracheal intubation and extubation in intensive care unit (ICU) patients are difficult. Extubation will be more worrisome if patient has difficult intubation, sleep apnea, surgical procedure involving airway or su...Endotracheal intubation and extubation in intensive care unit (ICU) patients are difficult. Extubation will be more worrisome if patient has difficult intubation, sleep apnea, surgical procedure involving airway or surrounding structures. In such extubation airway exchange catheters (AEC) are used, as they are simple to use and able to provide oxygen to the patient. Rarely AEC use can cause potential life threatening complications. We report a case of pneumothorax following use of AEC in post-thyroidectomy patient. Case: A 32 years old male patient was admitted to our ICU, with difficult intubation after thyroidectomy. He was a known case of obtructive sleep apnea, hypertension and large goiter. In ICU for proper visualization of vocal cords and resecuring the airway, AEC was used, but patient had hypoxia with bradycardia. He was recovered with Ambu bag ventilation and required brief cardiopulmonary resuscitation. Post resuscitation he had left impending tension pneumothorax and lung laceration requiring chest drain, which was removed after tracheostomy and weaned from the ventilator. After 9 days supra glottic edema subsided and vocal cords were moving;His trachea was decanulated and he was discharged home. Conclusion: Rarely AEC use can cause life threatening injuries. Pneumothorax following the use of AEC is not always due to tracheobronchial injury;it can also occur as a result of alveolar injury.展开更多
文摘Pregnancy and peripartum period leads to Virchow’s triad (hypercoagulability, venous stasis and vascular injury) thereby increasing the risk of thromboembolism by many folds in these patients. Accurate diagnosis of peripartum pulmonary embolism is pertinent for reducing morbidity and mortality. Accurate diagnosis is also vital for avoiding the adverse effects of unwanted anticoagulation in pregnant mother and fetus in a patient wrongly diagnosed with this condition. Computerized tomographic pulmonary angiography has a high specificity and sensitivity in comparison to ventilation/perfusion scan for diagnosis of peripartum pulmonary embolism (PPE). It has a lower fetal radiation exposure and aids in arriving at an alternative diagnosis, if PPE is absent. Low molecular weight heparin is the medication of choice in the treatment of peripartum pulmonary embolism. Thrombolysis is considered in patients with massive PPE and hemodynamic instability, refractory hypoxia or right ventricular dysfunction. Regional anesthesia/analgesia can be given safely in these patients. We report two cases of PPE and review the anesthetic and surgical consideration.
文摘Endotracheal intubation and extubation in intensive care unit (ICU) patients are difficult. Extubation will be more worrisome if patient has difficult intubation, sleep apnea, surgical procedure involving airway or surrounding structures. In such extubation airway exchange catheters (AEC) are used, as they are simple to use and able to provide oxygen to the patient. Rarely AEC use can cause potential life threatening complications. We report a case of pneumothorax following use of AEC in post-thyroidectomy patient. Case: A 32 years old male patient was admitted to our ICU, with difficult intubation after thyroidectomy. He was a known case of obtructive sleep apnea, hypertension and large goiter. In ICU for proper visualization of vocal cords and resecuring the airway, AEC was used, but patient had hypoxia with bradycardia. He was recovered with Ambu bag ventilation and required brief cardiopulmonary resuscitation. Post resuscitation he had left impending tension pneumothorax and lung laceration requiring chest drain, which was removed after tracheostomy and weaned from the ventilator. After 9 days supra glottic edema subsided and vocal cords were moving;His trachea was decanulated and he was discharged home. Conclusion: Rarely AEC use can cause life threatening injuries. Pneumothorax following the use of AEC is not always due to tracheobronchial injury;it can also occur as a result of alveolar injury.
