scholarly journals “I Can’t breathe”: Two Case Reports of Inadequate Reversal of Residual Muscle Paralysis

2021 ◽  
pp. 1-3
Author(s):  
J V Kapof ◽  
◽  
K U Tobi ◽  
Keyword(s):  
General Anaesthesia ◽  
Case Reports ◽  
Neuromuscular Function ◽  
Muscle Paralysis

Reversal of residual muscle paralysis is usually done at the end of a General Anaesthesia with Relaxant Technique (GART) before extubation. However, some patients may have inadequate reversal of their residual muscle paralysis. This may lead to persistent muscle paralysis despite the patient being awake from anaesthesia. A scenario of “I can’t breathe” therefore comes to play which is scary and discomforting to the affected patients. We hereby present two cases of inadequate reversal of residual muscle paralysis in our patients who underwent different procedures under general anaesthesia. The aim of this presentation is to highlight the need for adequate reversal of residual muscle paralysis, the need to routinely monitor neuromuscular function during general anaesthesia and to review the existing literature.

Cricothyroid muscle paralysis: its recognition and diagnosis

1989 ◽  
Vol 103 (2) ◽  
pp. 191-195 ◽  
Author(s):  
K. Bevan ◽  
M. V. Griffiths ◽  
M. H. Morgan
Keyword(s):  
Case Reports ◽  
Superior Laryngeal Nerve ◽  
Diagnostic Techniques ◽  
Laryngeal Nerve ◽  
Muscle Paralysis ◽  
Anatomy And Physiology ◽  
Cricothyroid Muscle

AbstractCricothyroid muscle paralysis is often missed as the symptoms are not dramatic and the laryngeal observations, on conventional indirect mirror examination, are inconclusive. The anatomy and physiology of the superior laryngeal nerve (SLN) and cricothyroid muscle are described. Three case reports are presented to illustrate our diagnostic techniques. Videofibrolaryngoscopy and electromyography are found to be invaluable tools for the diagnosis of this condition. The importance in diagnosing this entity is discussed.

scholarly journals Technical Aspects of Bronchopulmonary Lavage for Alveolar Proteinosis: Two Case Reports

1981 ◽  
Vol 9 (3) ◽  
pp. 277-285 ◽  
Author(s):  
G. A. Harrison ◽  
A. J. Kelly
Keyword(s):  
General Anaesthesia ◽  
Case Reports ◽  
Left Lung ◽  
Venous Admixture ◽  
Double Lumen ◽  
Technical Aspects ◽  
Lung Fluid ◽  
Alveolar Proteinosis ◽  
Double Lumen Endobronchial Tube ◽  
The Right

Under general anaesthesia, therapeutic bronchopulmonary lavage was performed in two patients suffering from alveolar proteinosis. In one patient, difficulties were experienced during attempted lavage of the right lung. Fluid trapping occurred when saline was infused down the tracheal (right) lumen of a Carlen's double lumen endobronchial tube and also when a left Robertshaw tube was similarly used. Spillover of saline into the left lung occurred when a right Robertshaw was used. Efficient lavage of the right lung could only be performed after insertion of a White endobronchial tube. In the second patient, both lungs were washed without problem using a left Robertshaw tube after difficulty had been experienced with a Carlen‘s tube. In both cases venous admixture was least when the lavaged lung was filled with saline. Hypoxaemia increased as the lung was drained. Details of technique are discussed as are problems with double lumen endobronchial tubes used during the procedure.

scholarly journals Fluoroscopy comes to the rescue in anaesthesia management of a case of ankylosing spondylitis

2021 ◽  
Vol 7 (2) ◽  
Keyword(s):  
General Anaesthesia ◽  
Epidural Anaesthesia ◽  
Regional Anaesthesia ◽  
Case Reports ◽  
Epidural Haematoma ◽  
Good Choice ◽  
Ultra Sound ◽  
Neuraxial Blockade ◽  
Spinal Haematoma ◽  
Increased Risk

Ankylosing spondylosis is always a challenge when patient has severe deformities to choose between general anaesthesia versus regional anaesthesia. Regional anaesthesia is always a choice either at institutionally or at smaller private hospital set ups. Schewley and colleagues compared regional versus general anaesthesia over 10 years and shown that regional anaesthesia is equally good choice.[1] There are many case reports which suggest that regional anaesthesia could be a safer option in severe Ankylosing spondylosis patients.[2] Author has managed to achieve neuraxial access by using fluoroscopy. However, interpretation of images by fluoroscopy could be difficult for anaesthetists without chronic pain management background. Also, availability of fluoroscopy could be variable as it may be busy in other theatres to be available later for surgery. Use of ultrasound to view spaces could be useful in cases with difficult neuraxial access to find the space. Most of the anaesthetists practising regional anaesthesia have expertise in using ultra-sound and also are comfortable to interpret the images. USG could also be helpful in pre-operative setting to identify and plan for central neuraxial blockade. [4] There are many case reports of use of USG guidance for neuraxial anaesthesia in such cases. [3] However, central neuraxial blocks in these patient comes with risks. The placement of epidural anaesthesia is technically difficult and is associated with an increased risk of an epidural haematoma. Wulf reported five out of 51 patients with spinal haematoma occurred in patients with AS in a comprehensive review of spinal haematoma associated with epidural anaesthesia over a 30?year period. These were related to difficult or traumatic insertion. In this his review article, he also mentions Ankylosing spondylosis as one of the risk factor for spinal or epidural haemoatoma. [5] Li et al also present a case report where patient developed epidural haematoma after epidura

scholarly journals Cardiac arrest during laparoscopic cholecystectomy under general anaesthesia: A study into four cases

1970 ◽  
Vol 7 (3) ◽  
pp. 280-288 ◽  
Author(s):  
B Gautam ◽  
BR Shrestha
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Arrest ◽  
Laparoscopic Cholecystectomy ◽  
General Anaesthesia ◽  
Open Abdomen ◽  
Case Reports ◽  
Co2 Pneumoperitoneum ◽  
Carbon Dioxide Pneumoperitoneum ◽  
Operative Complications ◽  
Carbon Dioxide Co2

Laparoscopic cholecystectomy (LapChole) has virtually superseded the more conventional open abdomen approach for the surgical treatment of symptomatic cholelithiasis. LapChole is however not a risk free procedure and serious, potentially fatal intra-operative complications can occur. Here we present case reports of four patients who suffered from intra-operative cardiac arrest during LapChole. All four recovered without residual morbidity and three of them underwent successful surgery in the same setting. No definite cause could be identified in any of the patients. We outline several possible mechanisms that could have been involved and discuss these events in face of published reports describing similar incidences. We infer that the creation of carbon-dioxide (CO2) pneumoperitoneum was involved in the causation of the cardiac arrest because all four incidences occurred within minutes thereafter. Although rare, such complications can be fatal and are thus demanding to the anaesthesiologist. Key words: Anaesthetic complications; carbon-dioxide pneumoperitoneum (CP); cardiac arrest; general anaesthesia; laparoscopic cholecystectomy DOI: 10.3126/kumj.v7i3.2738 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 280-288

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