Resuscitation 3

Endotracheal intubation was applied by Scheel in 1798 to resuscitate neonates. A century before endotracheal anaesthesia was developed, inventive obstetricians constructed devices for the endotracheal intubation of infants and mastered their insertion, localization, and airtight sealing. Fell’s laryngoscope, Magill’s intubation forceps, and tissue-friendly materials were significant 20th-century contributions to endotracheal intubation of the newborn. The striking absence of scientific studies on the most efficient resuscitation techniques for neonates is attributable to the difficulty of adjusting for personal skills of the resuscitator.

Caesarean delivery in T5 paraplegic following extended ICU stay in second trimester with absolute contraindication to neuraxial blocks

Pregnancy in patients with spinal cord injury presents unique challenges to their care teams. While spinal cord injury alters the function of several organ systems, one of the most important consequences is autonomic dysreflexia. Anaesthesia providers must be familiar with the pathophysiology and management of gravid patients with spinal cord injury to manage their deliveries successfully. A multidisciplinary team is essential; close collaboration between the obstetrical and anaesthesiology teams is crucial. The authors will present a case of a successful caesarean delivery in a woman with a T5 injury as well as a recent epidural abscess using general endotracheal anaesthesia.

Posterior Reversible Encephalopathy Syndrome as a Postpartum Complication

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological syndrome with seizures, altered consciousness, visual disturbances and headache among other symptoms. Hinchey et al. first described Pres in 1996, with two other case series published shortly after.CASE REPORT: A 23-year-old women patient was emergency sent from General Hospital Tešanj due to a crisis of consciousness and repeated epileptic seizures. The patient had a second birth before 10 days (postpartum cesarean) in general endotracheal anaesthesia (two cesarean-born babies). On magnetic resonance imaging (MRI) of cranium described both sides of the symmetrically frontal, parietal (and pre-ventricular gyri) and occipitally visible T2W/FLAIR hyperintensity focuses on the cortex and the thin layer of white mass subcortically. In the projection of the lesions parts, discrete DWI hyperintensity is seen without a reliable ADC correlate. The patient improved after management with intravenous fluids, antibiotics, antiepileptics and monitoring of blood pressure. According to latest experiences delayed diagnosis and treatment may lead to mortality or irreversible neurological deficit. Aggravating circumstances are differential diagnoses that include cerebral infarction (ischemic, haemorrhage), venous thrombosis, vasculitis, pontine or extrapontine myelinolysis.CONCLUSION: MRI of the brain is key to make this distinction with crucial recognition and an open mind from radiology and neurology specialist.

A large solitary fibrous tumour of the pleura: a case report and review of the literature

We report a clinical case of a solitary fibrous tumour of the pleura (SFTP) in a 67-year-old female patient complaining of chest pain for 2 months. A localized large mass was found in the left inferior hemithorax by computed tomography scan. The patient underwent a thoracotomy at the left side with endotracheal anaesthesia. During surgical resection, the tumour was located in the left inferior hemithorax and was attached to the inferior lobe of the left lung and diaphragmatic pleura by a fibrous pedicle. A wedge resection of the left lower lobe was undertaken to completely remove the tumour. Diagnosis of the SFTP was confirmed by the surgical findings and subsequent histological and immunohistochemical examinations. At the 6-month follow-up, no signs of local tumour recurrence or metastasis were documented. After a 3-year follow-up, this patient remains in good health.

Efficacy of sublingual nitroglycerine spray in attenuation of hemodynamics to tracheal extubation

Background: The present study was undertaken to evaluate efficacy of nitroglycerine (NTG) spray for attenuating haemodynamic response to tracheal extubation in normotensive and hypertensive patients.Methods: The study enrolling total 120 ASA I and II patients, (60 normotensive and 60 hypertensive) who had undergone elective surgery under general endotracheal anaesthesia. Both these types of patients were randomly subdivided into two groups of 30 patients each -50% receiving NTG spray and 50% not receiving NTG spray.Results: There was significant increase in heart rate in all four groups after NTG spray. During extubation this increased in heart rate was not statistically significant in group A (Normotensive with NTG) but was significant in group C (hypertensive with NTG) when compared with control groups. Similarly, during extubation there was significant rise in systolic, diastolic and mean arterial blood pressure were noted in all four groups and with use of NTG spray the increase could be significantly attenuated in NTG groups. Increase in heart rate along with reduction in blood pressure seen after NTG spray did not produce significant increase in RPP as compared to hypertensive and normotensive patients who did not receive the NTG spray.Conclusions: Sublingually administered nitroglycerin spray in a dose of 0.8 mg prior to extubation is an effective, practical, easy and relatively safe method in attenuate haemodynamic response to tracheal extubation.

Surgical angioplasty of the left main coronary artery

Introduction. The conventional treatment for isolated stenosis of the left main coronary artery is bypass surgery (myocardial revascularization). However, the process of atherosclerosis is not arrested by myocardial revascularization and it will lead to the occlusion of the left main coronary artery. Revascularization will establish retrograde perfusion for 50-70% of the myocardium of the left ventricle. Direct surgical angioplasty of the left main coronary artery enables normal physiological perfusion of the whole myocardium and better myocardial function. Objective. The aim of our study is to point out a new surgical approach of treating left main coronary artery stenosis. Methods. Between October 2002 and October 2003, direct surgical angioplasty of the main left coronary artery was performed on three patients with isolated stenosis of the left main coronary artery using the anterior approach and the pericardium as a patch. The procedure was performed under total endotracheal anaesthesia and standard cardiopulmonary circulation, moderate hypothermia, anterograde St. Tomas cardioplegia and local cooling. Patients were followed clinically, echocardiographically and by load-tests. Results. All three patients were without complications. In postoperative follow-up (54-68 months) neither angina pectoris nor electrocardiographically registered ischaemic changes were found. Load-tests performed every six months on all three patients were negative. Conclusion. Surgical angioplasty of isolated stenosis of the left main coronary artery is a preferred method for treating this type of coronary disease. Contraindications for this type of treatment are stenosis of the left main coronary artery with bifurcation and advanced calcification of the left main coronary artery.

The effect of smoking and forced use of the voice to development of the vocal polyps

Dysphonia is often caused by polyps which are benign changes of pseudotumors With their presence they are hampering with glotis oclusion Laryngomicroscopy of general and endotracheal anaesthesia has been preformed on all of the patients. Microsurgical technique has been used to remove the polyps. Bioptic material was analyzed in pathohystlogoical laboratory of clinic of pathology in Banjaluka. All of the results were presented through tables and graphic representations. Frequency of polyps through age and sex groups, along with the examination of ethyological factors in emergence of polyps of vocal cords. Results are in accordance with the results of other authors who were involved in similar problematics. Through analysis of our data we percieve that the abuse of voice is part of ethiological factors that lead not only to emergence of vocal fold lesions but as well as other benign changes.