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Biomedical subjects

J Littleford

Publications and source records attributed to J Littleford.

6 recordsLinked to original sources
PubMed2002

Mediastinal tumour in a pregnant patient presenting as acute cardiorespiratory compromise.

A parturient at 35 weeks' gestation presented with severe shortness of breath, orthopnea and signs of fetal compromise. She was diagnosed with a large mediastinal tumour occupying 65% of transthoracic diameter, and a pericardial effusion. The trachea, both mainstem bronchi, pulmonary artery and superior vena cava were compressed. Her dyspnea continued despite relief of the cardiac tamponade by percutaneous drainage. Tissue obtained via anterior mediastinotomy, performed under local anesthesia infiltration, revealed a definitive diagnosis of non-Hodgkin's lymphoma. The patient improved symptomatically following initiation of steroids and chemotherapy. She was delivered by elective cesarean section under epidural anesthesia on the fifth day after starting chemotherapy. The postoperative course was complicated by the development of a large pleural effusion that required drainage. Mother and baby were well at three and six-month follow up oncology visits.

Journal Article↗
PubMed2001

Goal oriented general anesthesia for Cesarean section in a parturient with a large intracranial epidermoid cyst.

PURPOSE: To illustrate the anesthetic management of a term parturient with a large brain tumour scheduled for Cesarean section. CLINICAL FEATURES: A 26-yr-old woman presented at 33 weeks gestation with a generalized grand mal seizure. Magnetic resonance imaging demonstrated a 5-cm multi-lobulated extra axial mass compatible with an epidermoid cyst, arising from the left temporal lobe associated with shift of the midline structures and compression of the brainstem. She remained stable neurologically until elective Cesarean section at 38 weeks. Immediately prior to induction of general anesthesia, the proposed incision site was infiltrated with lidocaine and the supraglottic structures anesthetized with bilateral superior laryngeal nerve blocks. Remifentanil, thiopentone sodium and succinylcholine were administered in a rapid sequence fashion following voluntary hyperventilation to an endtidal CO2 of 28 mmHg. Anesthesia was maintained with desflurane in oxygen/air and an infusion of remifentanil. Postoperative pain control was achieved using a multi-modal approach which included intraperitoneal deposition of local anesthetic, im ketorolac and rectal acetaminophen prior to emergence followed by regular administration of naproxen and acetaminophen for 72 hr. CONCLUSION: In a parturient with a large intracranial tumour, general anesthesia combined with multi-modal balanced analgesia met the predefined anesthetic management goals and was associated with a favourable outcome.

Adult↗
PubMed1996

Placement of left double-lumen endobronchial tubes with or without a stylet.

PURPOSE: This study was designed to determine if leaving a stylet in the left Bronch-Cath endobronchial tube (DLT) for the entire intubating procedure improves the accuracy of placement on the initial attempt, without introducing complications. METHODS: Sixty ASA 1-3 patients were randomized to one of two groups. In Group 1 (n = 30), the stylet was retained for the entire intubation procedure and in Group 2 (n = 30), the stylet was removed once the bronchial cuff had passed the vocal cords. In both groups, the DLT was turned 110 degrees counterclockwise and advanced until resistance was encountered. Placement was assessed by auscultation and fibreoptic bronchoscopy (FOB). After surgery, the DLT was replaced by a single-lumen endotracheal tube. The thoracic surgeon (blinded to the method of intubation, and using a FOB) assessed the appearance of the tracheobronchial mucosa. RESULTS: The two groups were similar with respect to sex, height, weight, DLT size, surgeon and expertise of the laryngoscopist. When the stylet was retained, the DLT was correctly placed 60% of the time compared with 17%, if the stylet was removed, (P = 0.001). Seven out of 30 DLTs in Group 2 were initially placed into the right mainstem bronchus, (P = 0.005). The average time to confirmation of correct tube placement by FOB was increased in Group 2, (P = 0.01). Although the observed incidence of left bronchial, mucosal petechiae and erythema was greater in Group 2, this was not statistically significant, (P = 0.063). CONCLUSION: Retaining the stylet for the entire intubation procedure allows for a more rapid, accurate placement of the DLT without increasing the incidence of tracheobronchial mucosa injury.

Bronchi↗
PubMed1996

Spinal anaesthesia for Caesarean section in a patient with a cervical arteriovenous malformation.

PURPOSE: Arteriovenous malformations (AVM) of the spinal cord are rare. We report the successful management of a patient with a cervical spinal cord AVM undergoing Caesarean section delivery, using a spinal anaesthetic. CLINICAL FEATURES: Based on previous radiological investigations, the patient was known to have an AVM at the third cervical level of her spinal cord. After application of monitors and intravenous administration of 1 L normal saline, a 25 g Whitacre needle was inserted into the subarachnoid space at the L3-4 interspace. Spinal anaesthesia was established with a solution consisting of hyperbaric spinal bupivacaine 12 mg, fentanyl 12.5 micrograms and epidural morphine 0.25 mg. There was no neurological deficit during hospital stay or after discharge. CONCLUSION: The safe outcome of spinal anaesthesia for our patient is encouraging. The presence of spinal cord AVM at the cervical region is not an absolute contraindication to spinal anaesthesia.

Adult↗