68 research outputs found
Refractory Hypotension after Tourniquet Deflation in a Patient on Chronic Clomipramine Therapy
No full textTreatment of intraoperative hypotension in a patient on chronic tricyclic antidepressant therapy(TCA) is contro-versial. Evidence based guidelines for the management of psychotropic drugs during perioperative period are lacking. We present a patient who was subjected to bilateral total knee replacement under combined spinal epidural anaesthe-sia. She developed refractory hypotension after release of tourniquet and responded only to large dosage of norepi-nephrine along with acid base correction. We believe that chronic TCA therapy led to depleted catecholamine re-serves and down regulation of its receptors. Release of tourniquet led to metabolic acidosis and subsequently in-creased free clomipramine concentration in blood leading to severe refractory hypotension
Bone Cement Implantation Syndrome: A Report of Four Cases
No full textCardiovascular collapse following use of methylmethacrylate for lower limb surgeries has been reported. How-ever there are no reports of cement reaction following shoulder arthroplasty. We report series of four patients exhibiting cement reaction. Two of our patients had cardiovascular collapse following cement insertion during hip arthroplasty. Severe hemodynamic derangement and transient hypoxemia was observed during cemented arthro-plasty of shoulder and knee respectively. Peripheral vasodilatory effects of the cement monomer, fat and marrow embolism and activation of the clotting cascade in the lungs, all contribute to cement reaction. Early and aggressive resuscitation with use of vasopressors, establishment of invasive hemodynamic monitoring and surgical modifications are the key to prevention of catastrophic outcome
Laparoscopic Conventional Abdominoperineal (CAPE) and Extra-Levator Abdominoperineal Resection (ELAPE)
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