A patient in good general condition and a negative clinical history was anaesthetised for right lower extremity varices. Preanaesthesia with 10 mg diazepam and 0.3 mg atropine 45 min prior to surgery was followed by uneventful induction with thiopental sodium and succinylcholine orotracheally, and maintenance with N2O, O2 and Ethrane in standard percentages. Muscle relaxation was obtained with pancuronium bromide. Automatic ventilation was used to maintain a VT of 12 ml per kg body weight and a respiration rate of 10 breaths per minute. At the end of the operation, 2.5 mg neostigmine and 1.5 mg atropine were given. Since the patient failed to breather spontaneously, automatic ventilation was resumed and 0.4 mg naloxone were administered i.v. After about 2 min, the patient exhibited the classic signs of left ventricular insufficiency, with BP 260/150 mmHg, clinical evidence of acute pulmonary oedema, and an ECG showing atrial tachycardia and variable A-V block. Treatment with PEEP and i.v. furosemide led to spontaneous resolution of the clinical picture, and early normalisation of the ECG. The part played by naxolone in this picture is discusses with reference to similar cases in the literature. It is felt that massive release of catecholamines in response to pain after administration of naloxone is capable of triggering the typical clinical picture of left ventricular insufficiency. The possible role of naloxone vis-à-vis opium and endorphin receptors is also discussed.

Adult↗

PubMedDate not supplied

[Naloxone and clinical anesthesia].

The narcotic-antagonist properties of naloxone make it useful in cases of postoperative respiratory depression arising after morphine, the various forms of LAN, or extra- and subdural anaesthesia with narcotics. The dose should be adapted to the individual patient, since the drug has certain drawbacks (heart rate disturbances, hypertension crises). The following guidelines are suggested: 1) administration of 0.1 mg increments i.v. until autonomous breathing is restored; 2) administration of 50% of the initial dose i.m. afer 30'; 3) keep the patient under observation for at least 4-6 hr from the end of the operation.

Anesthesia↗

PubMedDate not supplied

[Coma in myxedema. Clinical contribution].

Coma due to myxoedema was first reported in 1879, and recent surveys have shown that only 150 cases are mentioned in the literature. Two cases successfully treated in a resuscitation department over the last six years are presented. The problems presented by patients of this type are discussed, and stress is laid on the importance of resuscitatory and intensive management, at least until resolution of the coma.

Aged↗

PubMedDate not supplied

[Anesthesia problems in reconstructive vascular surgery of the lower extremities].

Explore the source record for details and available documents.

Adult↗

PubMedDate not supplied

[Botulinum poisoning in adults: a case report and differential diagnosis].

The authors reports the case of a patient with quadriplegia associated with respiratory failure. A few days before, a paralysis of the oculomotor nerves appeared, which rapidly spreads in cranio-caudal fashion. The occurrence of a similar symptomatology in a patients' relative addressed the diagnosis toward a possible Clostridium botulinum intoxication. Other possible differential diagnoses are reviewed and discussed.

Botulism↗

PubMedDate not supplied

[Occurrence of acute refractory hypotension during laparoscopic cholecystectomy. Report of a case and review of the literature].

The authors report the case of a patient who developed irreversible cardiovascular collapse during a laparoscopic cholecystectomy. The abrupt onset of shock and the rapid deterioration of the hemodynamic conditions prevented a thorough diagnostic workup. Possible differential diagnoses of hypotension occurring during laparoscopic procedures are reviewed and discussed.

Acute Disease↗