We present a case of malignant neuroleptic syndrome in a 55 years old male diagnosed 3 years ago of alcoholic paranoid psychosis who was chronically treated with haloperidol, clothiapine, and phenobarbital. Twenty one days after neuroleptic drug withdrawal the patient was admitted to the recovery room because of hyperthermia (40.2 degrees C), left basal pneumonia, acute respiratory insufficiency, extrapyramidal rigidity, mutism, dysarthria, deep coma, hypotension, and tachycardia. Two days after he presented massive rhabdomyolysis, atrial flutter with hemodynamic deterioration which reverted to sinus rhythm and acute anterolateral and inferior myocardial infarction documented by enzyme rise and electrocardiographic alterations. Rhabdomyolysis and myocardial infarction were the precipitating factors of the renal insufficiency. A malignant neuroleptic syndrome was suspected and intravenous treatment with dantrolene sodium 1.5 mg/kg every 24 hours was initiated. Bromocriptine was not administered. The patient died 14 days after in the course of a sepsis and cardiogenic shock.

Acute Kidney Injury↗

PubMedDate not supplied

[Induction and maintenance of anesthesia with propofol and with thiopental-isoflurane. Comparative study].

Thirty one patients of both sexes, ASA I-II, aged 18-65 years have undergone a randomized trial in order to compare two anesthetic techniques. Patients in group I (n = 15) received a 2.5 mg/kg induction dose of propofol followed by a continuous infusion of the same drug at 3.6-9 mg/kg/h. Patients in group II (n = 16) were induced with 4 mg/kg thiopentone and maintained with 0.5-1.5% isoflurane. Both groups were evaluated for time and quality of induction, collateral effects, quality and hemodynamic stability during maintenance and time and quality of recovery. Induction time for patients in group I (49.6 +/- 15 seg) was significantly longer than for group II patients (23 +/- 3 seg) (p less than 0.01). Respiratory depression (apnea period longer than 20 seconds) was also commoner and longer in group I (p less than 0.01) although no problems were observed with manual ventilation. One patient in group I required an extra dose for induction. Both groups had similar hemodynamic changes along the procedure. Awakening time for patients in group I (24.2 +/- 7.3 min) was significantly longer than for patients in group II (14.3 +/- 4.4 min) (p less than 0.001). Although surgery times were longer in group I, a possible cumulative effect of propofol for infusions over 90 min cannot be discarded.

Adolescent↗

PubMedDate not supplied

[Necrosis of the hand produced by cannulation of radial artery].

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Adult↗

PubMedDate not supplied

[Anesthesia in a patient with toxic epidermal necrolysis].

We report the case of a 16-month-old boy weighing 11 kg who presented toxic epidermal necrolysis secondary to phenobarbital administration and underwent emergency laparotomy under general anesthesia because of gastrointestinal bleeding. The boy presented epidermal detachment on the slightest friction (Nikolsky's sign) so monitoring was difficult; in these cases it is advisable to use padded sphygmomanometers and weighted electrodes. Owing to the great extension of denuded skin, these patients must be considered as hypovolemic and ketamine is the drug of choice for anesthesia induction. The maintenance of airways and the proper replacement of fluids and electrolytes are essential for the correct anesthetic treatment of these patients.

Anesthesia↗