Anaesthesia case studies

Although intravenous anaesthetics can inhibit in-vitro the activity of PMNs, " their in-vivo effect on the phagocyte-dependent immune system is not clearly defined especially in cases of short term anaesthesia. Our study indicates that PMN CL, if analyzed by an appropriate statistical test, seems to be modified also by short term intravenous anaesthesia. In fact, both discriminant analysis (Table 2) and regression analysis between luminol- and lucigenin-dependent CL (Figure 1) indicate that PMN CL is modified also after many hours of a short time intravenous anaesthesia. In... 

Enflurane is metabolised by the cytochrome P-450 series, specifically P-450 2E1, but the agent is much less extensively metabolised than halothane (see above). Metabolites include trifluoroacetic acid (TEA) and inorganic fluoride ion. A small number of cases of enflurane hepatitis have been reported but the overall incidence of liver damage following enflurane anaesthesia is estimated to be 1 in 800000. Clinical studies have failed to detect any significant effects of enflurane on liver function even when given repeatedly. 

Gannon K. Mortality associated with anaesthesia. A case review study. Anaesthesia 1991 46(ll) 962-6. 

In 1965 a study showed that ecothiopate iodide eye drops could markedly lower pseudocholinesterase levels. It was noted that ... within a few days of commencing therapy, levels are reached at which protracted apnoea could occur, should these patients require general anaesthesia in which muscle relaxation is obtained with succinylcholine . Cases of apnoea due to this interaction were reported the following year, and other cases have been subsequently reported. In one case a woman given suxamethonium (succinylcholine) 200 mg showed apnoea for 5 /2 hours. Other stud-... 

There is some evidence that the presence of amiodarone possibly increases the risk of complications (atropine-resistant bradycardia, hypotension, decreased cardiac output) during general anaesthesia. All cases were with fentanyl-based anaesthesia, but some other studies have shown no problems with fentanyl-based anaesthesia. 

A study in 6 healthy subjects receiving 30-hour infusions of lidocaine at a rate of 2 mg/minute found that pretreatment with propranolol 80 mg every 8 hours for 3 days raised the steady-state plasma lidocaine levels by 19% (from 2.1 to 2.5 micrograms/mL) and reduced the plasma clearance by 16%. Other similar studies have found a 22.5 to 30% increase in steady-state serum lidocaine levels and a 14.7 to 46% fall in plasma clearance due to the concurrent use of propranolol. Two cases of lidocaine toxicity attributed to a lidocaine-propranolol interaction were revealed by a search of the FDA adverse drug reaction file in 1981. A further case of lidocaine toxicity (seizures) has been described in a man on propranolol after accidental oral ingestion of lidocaine for oesophageal anaesthesia. High serum levels of lidocaine were detected. ... 

Information seems limited, and sinee lidoeaine is not usually given orally the praetieal importance is minor. However, lidoeaine is used for oro-pha-ryngeal topical anaesthesia, and there have been cases of toxicity after accidental ingestion. Thus, in a patient on erythromycin, the toxicity of ora lidoeaine may be markedly increased. Further study is required to assess the significance of the increase in MEGX during prolonged intravenous lidoeaine infusions. 

On the wider scale, ionised calcium in sera measured with the calcium ion-selective electrode have helped in studying the direct effect of calcium on the hyperparathyroidism of chronic renal failure when it was shown that rats on low calcium diet developed larger parathyroids and more severe bone disease at the end of four weeks while diets with above normal calcium levels produced no additional benefits [130]. Other studies include the relation between hypercalcemia and normal ionised serum calcium in a case of myelomatosis [86], the detection of hypocalcemia in susceptible neonates [68], and studies on serum ionised calcium changes following citrated blood transfusion in anaesthetised subjects [93]. The transfusion studies showed six patients during anaesthesia to have a decrease of 0.135 mmol dm" after 500 cm and 0.15 mmol dm" after 1000 cm blood, respectively. However, the calcium ion concentration increased by a mean of 0.075 mmol dm" in 10 min following complete infusion of the blood [93]. 

Rifampicin Profound hypotension following propofol induction of anaesthesia in a patient treated with two preoperative doses of rifampicin for antibiotic prophylaxis prior to spinal surgery is reported [96 ]. Anecdotal reports of similar experiences within the same institution prompted a retrospective case-control study... 

Aronski et al. (45 ) studied systolic time intervals and peripheral blood flow in 12 patients after induction of anaesthesia with 0.05 ml/kg body weight Althesin and concluded that the drug has a definite cardio-depressive action. In another series of 220 patients (46 ) tachycardia and hypotension were seen in 35 and 25% of cases respectively. The respiratory depressant effect of the drug was related to the speed of injection. Muscle tremors were absent when Althesin was given by intravenous infusion. Even convulsions after Althesin have been described, immediately after the injection (4 C) or, in the case of less rapid injection, after some delay (48C). The slow injection of Althesin can indeed reduce the incidence of aU its side effects, as was shown in a comparison between 2 groups of 30 patients in which differing rates of administration were employed (49C). 

Based on an extensive review (with 679 references cited) Usubiaga (3 ) concludes that although epidural anaesthesia is much safer than intradural, neurological complications after the epidural anaesthesia can occur. His literature study located 69 cases of such adverse reactions. 

Hypersensitivity reactions of the skin and respiratory system have been reported in a study made at random of 750 orthopaedic surgery cases, who received 5 different plasma substitutes preceding anaesthesia. Side effects, especiahy erythema and urticaria, itching and oedemata, rhinorrhoea and asthmatic conditions, were observed in 21.3% with gelatin derivatives, 3% with Macrodex... 

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