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Category: Complications of Anaesthesia

With greater understanding of the complications of irrigation fluids and the correlated pathophysiology, anaesthesiologists should be better able to stratify risk and improve the quality of perioperative care. Irrigation fluid–associated complications, including TURP syndrome, may present subtly, necessitating a low threshold to initiate focused physical examination and investigations. Supportive treatment is the mainstay of initial intervention.

Pre-oxygenation is: safe,simple,cheap,effective,well-tolerated. This article provides a compelling argument in favour of pre-oxygenation prior to all general anaesthesia.

Conduct a focused history and full physical examination for all patients with cardiac electronic devices Gather important information regarding the device: its make and model, basic programming features, battery life, and the underlying rhythm Involve the cardiology team responsible for management of the device as early as possible in the patient’s perioperative care Confirm the location of the operation in relation to the device and consider deactivating it if exposure to significant electromagnetic interference is expected Always have an backup plan in case of device malfunction Magnets should only be used after consultation with the cardiologist responsible for the patient’s care.

Aspiration was first recognised as a cause of an anaesthetic-related death in 1848 by James Simpson. Much later in 1946, Mendelson described the relationship between aspiration of solid and liquid matter, and pulmonary sequelae in obstetric patients. Today it remains a rare but potentially devastating complication of general anaesthesia, quoted as occurring in between 1 in 3000 and 1 in 6000 anaesthetics. This increases to 1 in 600 for emergency anaesthesia in adults.

Malaria is one of the most successful parasites ever known to mankind. After thousands of years, it remains the world’s most pervasive infection, affecting 300-500 million people annually. One million people die each year from malaria - the majority are children under five. A child dies every 30 seconds from malaria, many just days after infection. Ninety percent of these deaths occur in Sub-Saharan Africa. With the high prevalence of malaria, it is important that the anaesthetist practising in the developing world is familiar with the clinical aspects of the disease.

Malignant hyperthermia (MH) is a rare but potentially fatal condition triggered by suxamethonium or an anaesthetic vapour. Early recognition of signs and prompt treatment are essential. The pathophysiology, clinical features and treatment of MH are described, with an emphasis on management and prevention in poorly- resourced settings.

Post dural puncture headache (PDPH) was first reported just over one hundred years ago. PDPH has the potential to cause considerable morbidity and is a complication that should not to be treated lightly. PDPH is usually a self-limiting process. If left untreated, 75% resolve within the first week and 88% resolve by 6 weeks. Most treatments are geared towards lessening the pain and symptoms until the hole in the dura can heal, or at least until it can close to the point where the symptoms are tolerable. PDPH continues to be a common morbidity despite several innovations in equipment and techniques used for spinal (subarachnoid) and epidural (extradural) anaesthesia.

Latex is a protein, processed from the sap of the rubber tree (Hevea brasiliensis). Not all products that are labelled as “latex” contain this product and therefore may not induce allergy in susceptible individuals. Susceptibility is determined by cumulative life exposure to one or more latex proteins or the chemicals used in its manufacture.

In 2004, 3.4 million blood components were issued in the UK and 539 events were voluntarily reported to the Serious Hazards of Transfusion Scheme (SHOT). This represents an increase of 19% over 2003. Data collected as reporting became compulsory are not yet available ( 1

Suxamethonium (succinylcholine) apnoea occurs when a patient has been given the muscle relaxant suxamethonium, but does not have the enzymes to metabolise it. Thus they remain paralysed for an increased length of time and cannot breathe adequately at the end of an anaesthetic.

Perioperative neuropathies, vision loss, and positioning-related problems have received increasing attention from the lay press, plaintiffs’ lawyers, the anesthesiology community, and clinical researchers in recent years. This review will provide an update of current findings and discuss possible mechanisms of injury for these potentially devastating problems.

Postoperative nausea and vomiting (PONV) are among the most common adverse events following surgery, anaesthesia and opioid analgesia. Although usually of minor medical impact, they can cause a lot of distress, lead to delayed hospital discharge and increased use of resources. The aetiology of PONV is multifactorial, involving physiological, pathological and pharmacological factors.

At the end of anaesthesia and surgery the patient should be awake or easily rousable, protecting their airway, maintaining adequate ventilation and with their pain under control. Time to emerge from anaesthesia is very variable and depends on many factors related to the patient, the type of anaesthetic given and the length of surgery.