1/38. Fatal pulmonary haemorrhage during anaesthesia for bronchial artery embolization in cystic fibrosis.Three children with cystic fibrosis (CF) had significant pulmonary haemorrhage during anaesthetic induction prior to bronchial artery embolization (BAE). Haemorrhage was associated with rapid clinical deterioration and subsequent early death. We believe that the stresses associated with intermittent positive pressure ventilation (IPPV) were the most likely precipitant to rebleeding and that the inability to clear blood through coughing was also an important factor leading to deterioration. Intermittent positive pressure ventilation should be avoided when possible in children with CF with recent significant pulmonary haemorrhage.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/38. Internal iliac artery embolisation for intractable bladder haemorrhage in the peri-operative phase.Intractable haemorrhage from the bladder wall during transurethral resection of bladder tumour is uncommon but potentially catastrophic. Internal iliac artery embolisation is a minimally invasive technique, which is now widely practised to stop bleeding from branches of these arteries is situations including pelvic malignancy, obstetric and gynaecological emergencies and trauma. We report its successful use peri-operatively, in an unfit, elderly patient with uncontrolled bleeding.- - - - - - - - - - ranking = 0.83333333333333keywords = haemorrhage (Clic here for more details about this article) |
3/38. life-threatening haemorrhage following obturator artery injury during transurethral bladder surgery: a sequel of an unsuccessful obturator nerve block.In spite of prior blockade of the obturator nerve with 1% mepivacaine (8 ml) utilizing a nerve stimulator, violent leg jerking was evoked during transurethral electroresection of a bladder tumour approximately 1 h after the blockade in a 68-year-old man. The patient became severely hypotensive immediately following the jerking, and a large lower abdominal swelling concurrently developed. The urgent laparotomy indicated that the left obturator artery was severely injured by the resectoscope associated with the bladder perforation, causing acute massive haemorrhage. The patient recovered uneventfully after adequate surgery. Investigation of the literature suggested that both our nerve stimulation technique and anatomical approach were appropriate. It was therefore unlikely that our block resulted in failure because of an inappropriate site for deposition of the anaesthetic. However, consensus does not appear to have been obtained as to the concentration and volume of the anaesthetic necessary for prevention of the obturator nerve stimulation during the transurethral procedures. The concentration and volume of mepivacaine we used might have been too low and/or small, respectively, to profoundly block all the motor neuron fibres of the nerve. Alternatively, stimulation of the obturator nerve might occur because of the presence of some anatomical variant, such as the accessory obturator nerve or its abnormal branching. In conclusion, some uncertainty appears to exist in the effectiveness of the local anaesthetic blockade of the obturator nerve. In order to attain profound blockade of the motor neuron fibres of the obturator nerve and thereby prevent the thigh-adductor muscle contraction which can lead to life-threatening situations, we recommend, even with a nerve stimulator, to use a larger volume of a higher concentration of local anaesthetic with a longer duration in the obturator nerve block for the transurethral procedures.- - - - - - - - - - ranking = 0.83333333333333keywords = haemorrhage (Clic here for more details about this article) |
4/38. Anaesthetic management of liver haemorrhage during laparotomy in a premature infant with necrotizing enterocolitis.The case of a 680 g premature baby who developed massive spontaneous liver haemorrhage during laparotomy for necrotizing enterocolitis is reported. The infant survived due to rapid and massive fluid administration, including transfusion of large volumes of blood and blood products, in combination with high dose inotropic support and the surgical use of packing with thrombostatic sponges. Good venous access, including two central venous lines, turned out to be very useful.- - - - - - - - - - ranking = 0.83333333333333keywords = haemorrhage (Clic here for more details about this article) |
5/38. Iatrogenic injuries of renal pelvis and ureter following open surgery for urolithiasis.OBJECTIVE: To study the types of injuries of renal pelvis and ureter following open surgical procedures for urolithiasis and predisposing factors leading to such injuries and discuss various options for the management of iatrogenic injuries of the renal pelvis and ureter. patients AND METHOD: Case files and available radiographs of the patients who were managed for ureteral and renal pelvic injuries were reviewed. Initial procedure, mode of injury and clinical course were noted. RESULTS: The study consisted of 13 patients (9 males and 4 females). Age of the patients ranged from 18 to 65 years. Eight patients had injuries of renal pelvis or ureteropelvic junction and 5 patients got ureteral injuries. Primary management of ureteral and renal pelvic injuries was successful in 9 patients. Four patients required further surgery. Three out of 4 patients underwent nephrectomy and in 1 patient renal function deteriorated despite secondary pyeloplasty. Among 3 patients who had nephrectomy, one died postoperatively due to sepsis and haemorrhage. CONCLUSION: Injuries of the renal pelvis and ureter have significant morbidity and even mortality. Peroperative recognition of these injuries and appropriate management can prevent the late sequele of these injuries such as stricture formation leading to progressive renal damage.- - - - - - - - - - ranking = 0.16666666666667keywords = haemorrhage (Clic here for more details about this article) |
6/38. Postoperative extracorporeal membrane oxygenation for severe intraoperative SIRS 10 h after multiple trauma.A 34-yr-old male suffered multiple trauma in a road traffic accident. He required right thoracotomy and laparotomy to control exanguinating haemorrhage, and received 93 u blood and blood products. Intraoperatively, he developed severe systemic inflammatory response syndrome (SIRS) with coagulopathy and respiratory failure. At the end of the procedure, the mean arterial pressure (MAP) was 40 mm Hg, arterial blood gas analysis showed a pH of 6.9, Pa(CO(2)) 12 kPa, and Pa(O(2)) 4.5 kPa, and his core temperature was 29 degrees C. There was established disseminated intravascular coagulation. The decision was made to stabilize the patient on veno-venous extracorporeal membrane oxygenation (ECMO) only 10 h after the accident, in spite of the high risk of haemorrhage. The patient was stabilized within 60 min and transferred to the intensive care unit. He was weaned off ECMO after 51 h. He had no haemorrhagic complications, spent 3 weeks in the intensive care unit, and has made a good recovery.- - - - - - - - - - ranking = 0.33333333333333keywords = haemorrhage (Clic here for more details about this article) |
7/38. Emergency pelvic packing to control intraoperative bleeding after a Piver type-3 procedure. An unusual way to control gynaecological hemorrhage.We report a case of gynaecologic haemorrhage after a Piver type-3 procedure treated by a packing technique. The postoperative course was uneventful and the packs were removed after six days. Intra-abdominal packing should be familiar to both obstetricians and gynecologists because when any other attempt to provide hemostasis fails, it can be the last successful way to control a life-threatening haemorrhage.- - - - - - - - - - ranking = 0.33333333333333keywords = haemorrhage (Clic here for more details about this article) |
8/38. Acute intraoperative cerebral oedema: are current therapies evidence based?Acute intraoperative ischaemic cerebral oedema following torrential haemorrhage from the left intracranial internal carotid artery occurred during resection of a recurrent middle cranial fossa meningioma. A series of immediate anaesthetic interventions was effective in reducing brain oedema, allowed for surgical haemostasis, and resulted in no permanent sequelae to patient outcome. A review of the literature indicates that direct evidence for the efficacy of extremely early interventions as described in this case report is lacking and must be extrapolated from other brain injury models.- - - - - - - - - - ranking = 0.16666666666667keywords = haemorrhage (Clic here for more details about this article) |
9/38. Necrotizing crepitant cellulitis of the abdominal wall following a caesarean section and subsequent hysterectomy.A case report of necrotizing crepitant cellulitis of abdominal wall following caesarean section is presented. Because of intense haemorrhage it was namely necessary to perform additional hysterectomy and bilateral hypogastric artery ligation. Serious wound infection and sepsis were successfully treated by administration of antibiotics and repeated deep incisions.- - - - - - - - - - ranking = 0.16666666666667keywords = haemorrhage (Clic here for more details about this article) |
10/38. The use of an overlay autogenous tissue (OAT) patch to control intra-operative haemorrhage of the spleen.BACKGROUND: During major abdomino-pelvic surgery, there is a risk of severe haemorrhage. When routine measures at haemostasis fail, the overlay autogenous tissue (OAT) patch may be useful to control bleeding. CASE: We present a case report of the use of the use of an OAT patch to control haemorrhage of the spleen incurred during tertiary cytoreduction. CONCLUSION: The OAT patch should be considered in situations where bleeding is unable to be controlled after routine measures have failed and in instances other than for vascular injury alone. This technique has implications for practice in a wide range of gynaecologic oncology surgery.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
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