<b>Background:</b> Accidental awareness during general anesthesia (AAGA) is an uncommon condition with possible long-term sequela. Here, we identify and describe a case of awareness in the perioperative se...<b>Background:</b> Accidental awareness during general anesthesia (AAGA) is an uncommon condition with possible long-term sequela. Here, we identify and describe a case of awareness in the perioperative setting and the resulting sequelae of symptoms consistent with post-traumatic stress disorder using the first-hand experience of a patient with awareness during anesthesia. <b>Aim:</b> This case report aims to identify and describe the symptomatic sequelae of perioperative awareness events and the importance of close patient follow-up and management. <b>Case Presentation:</b> A 34-year-old female developed uncontrolled tonsillar hemorrhage 2 days after successful adenotonsillectomy that necessitated bedside intubation. During regular clinic follow-up, the patient presented with symptoms suggestive of post-traumatic stress disorder (PTSD) secondary to recall events while under anesthesia. <b>Conclusion:</b> The contributory factors predisposing to perioperative awareness in the surgical environment need to be understood and avoided as much as possible. When awareness is suspected or known to have occurred the patient needs to be assisted through the post-op period and guided through the psychological sequelae that follow.展开更多
The objective of the study was to compare the concentration of lidocaine in different body fluids/tissues after subarachnoid space and intravenous administrations of a lethal dose of lidocaine.Totally 18 dogs were use...The objective of the study was to compare the concentration of lidocaine in different body fluids/tissues after subarachnoid space and intravenous administrations of a lethal dose of lidocaine.Totally 18 dogs were used in the experiment.Six dogs were given subarachnoid anesthesia,another were given an intravenous injection of a dose of 75 mg/kg weight of lidocaine hydrochloride in 5 min and the last 6 dogs were used as the blank control dogs and given a subarachnoid space injection or a femoral artery injection of the same volume of sodium chloride.As soon as its vital signs disappeared,each dog was dissected and the specimen,such as brain,cerebrospinal fluid(CSF)in lateral ventricle,CSF in subarachnoid space,spinal cord(cervical spinal cord,thoracic spinal cord,lumbar spinal cord,and waist spinal cord),heart,lung,liver,spleen,kidney,bile,urine,heart blood,peripheral blood,muscle in injection location,and muscle in no injection location,were collected for analysis of lidocaine immediately.Analysis was performed with gas chromatography‑mass spectrometry(GC‑MS).From the maximum to the minimum,the order of lidocaine concentration detected in the subarachnoid space‑administered dogs was as follows:CSF in subarachnoid space,waist spinal cord,thoracic spinal cord,CSF in lateral ventricle,lumbar spinal cord,cervical spinal cord,lung,kidney,muscle in injection location,heart,brain,spleen,heart blood,liver,peripheral blood,bile,muscle in no injection location,and urine.The order of lidocaine concentration detected in the intravenously administered dogs was as followed:Kidney,heart,lung,spleen,brain,liver,peripheral blood,bile,heart blood,cervical spinal cord,thoracic spinal cord,muscle in injection location,lumbar spinal cord,muscle in no injection location,CSF in subarachnoid space,urine,and CSF in lateral ventricle.The maximum concentration of lidocaine was detected in the subarachnoid space CSF of subarachnoid space‑administered dead dogs,while in intravenously injected dead dogs,the maximum concentration of lidocaine was detected in the kidney.Our study provides some useful data for the forensic identification of epidural anesthesia accidents to decide the way the lidocaine enters the body.展开更多
文摘<b>Background:</b> Accidental awareness during general anesthesia (AAGA) is an uncommon condition with possible long-term sequela. Here, we identify and describe a case of awareness in the perioperative setting and the resulting sequelae of symptoms consistent with post-traumatic stress disorder using the first-hand experience of a patient with awareness during anesthesia. <b>Aim:</b> This case report aims to identify and describe the symptomatic sequelae of perioperative awareness events and the importance of close patient follow-up and management. <b>Case Presentation:</b> A 34-year-old female developed uncontrolled tonsillar hemorrhage 2 days after successful adenotonsillectomy that necessitated bedside intubation. During regular clinic follow-up, the patient presented with symptoms suggestive of post-traumatic stress disorder (PTSD) secondary to recall events while under anesthesia. <b>Conclusion:</b> The contributory factors predisposing to perioperative awareness in the surgical environment need to be understood and avoided as much as possible. When awareness is suspected or known to have occurred the patient needs to be assisted through the post-op period and guided through the psychological sequelae that follow.
基金funded by the National Natural Science Foundation Council of China(No.81172906)the National Key Technology R&D Program of China(No.2012BAK02B02-2)International technology cooperation plan project in Shanxi Province(No.2012081053).
文摘The objective of the study was to compare the concentration of lidocaine in different body fluids/tissues after subarachnoid space and intravenous administrations of a lethal dose of lidocaine.Totally 18 dogs were used in the experiment.Six dogs were given subarachnoid anesthesia,another were given an intravenous injection of a dose of 75 mg/kg weight of lidocaine hydrochloride in 5 min and the last 6 dogs were used as the blank control dogs and given a subarachnoid space injection or a femoral artery injection of the same volume of sodium chloride.As soon as its vital signs disappeared,each dog was dissected and the specimen,such as brain,cerebrospinal fluid(CSF)in lateral ventricle,CSF in subarachnoid space,spinal cord(cervical spinal cord,thoracic spinal cord,lumbar spinal cord,and waist spinal cord),heart,lung,liver,spleen,kidney,bile,urine,heart blood,peripheral blood,muscle in injection location,and muscle in no injection location,were collected for analysis of lidocaine immediately.Analysis was performed with gas chromatography‑mass spectrometry(GC‑MS).From the maximum to the minimum,the order of lidocaine concentration detected in the subarachnoid space‑administered dogs was as follows:CSF in subarachnoid space,waist spinal cord,thoracic spinal cord,CSF in lateral ventricle,lumbar spinal cord,cervical spinal cord,lung,kidney,muscle in injection location,heart,brain,spleen,heart blood,liver,peripheral blood,bile,muscle in no injection location,and urine.The order of lidocaine concentration detected in the intravenously administered dogs was as followed:Kidney,heart,lung,spleen,brain,liver,peripheral blood,bile,heart blood,cervical spinal cord,thoracic spinal cord,muscle in injection location,lumbar spinal cord,muscle in no injection location,CSF in subarachnoid space,urine,and CSF in lateral ventricle.The maximum concentration of lidocaine was detected in the subarachnoid space CSF of subarachnoid space‑administered dead dogs,while in intravenously injected dead dogs,the maximum concentration of lidocaine was detected in the kidney.Our study provides some useful data for the forensic identification of epidural anesthesia accidents to decide the way the lidocaine enters the body.
