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[Maternal pulmonary edema as an anesthesia complication after intravenous tocolysis and stimulating of lung maturation].

Maternal lung edema due to the use of beta-mimetic tocolytic agents is a well-documented complication. The risk increases if several other factors are present: infectious diseases, the use of inhaled anesthetics, EPH gestosis, hydramnios, twin gestation and preexisting cardiovascular disease. The complications induced by beta-mimetic tocolytic agents can be reduced by remembering their side effects and contraindications and restricting fluid intake. During obstetric general anesthesia in patients undergoing tocolysis, the infusion of large amounts of saline, as is widely practised today, is strictly contraindicated.

Adrenal Cortex Hormones↗

[Pheochromocytoma as an unexpected anesthesia complication].

A 51 year old woman patient with undiagnosed hypertension and established diabetes mellitus was to undergo hysterectomy. The induced neurolept-analgesia was interrupted because of sudden increase in the heart rate. Plasma adrenaline and noradrenaline values showed an approximately 12-fold increase. With signs of an extreme peripheral vasoconstriction, the patient died about 11 h after the start of anaesthesia. The post-mortem revealed an apricotsized, hormonally active pheochromocytoma of the left suprarenal body. Following investigation of the pathophysiological and pharmacological process, the case is analyzed from the medico-legal view, the non-clarification of the hypertension as objective failure to exercise due care is put up for discussion, and the question of causality and imputation discussed. Anesthesia in the presence of an undetected pheochromocytoma may be so rare that the criterion of adequacy, i.e. the objective predictability, cannot be applied. None the less the case demonstrates once again the physician's special duty to exercise due care. A precondition for any responsible choice of therapy must be accurate and comprehensive compilation of the findings.

Adrenal Gland Neoplasms↗

[Diaphragmatic rupture in the domestic cat--pathophysiology and anesthesia complications].

The high mortality in animals with diaphragmatic hernia has been related to profound cardiopulmonary dysfunction. Shock, liver disease and renal failure are among the most common causes of death. 18 cats with traumatic diaphragmatic hernia were anaesthetized. The duration of diaphragmatic hernia ranged from a few hours to 9 months. With the exception of transient cardiac dysrhythmias or weak pulse pressures which occurred in some cats only, anaesthesia was uneventful in 14 cats. Four cats out of 18 died either during surgery (n = 2) or within the following 24 hours (n = 2). Pathophysiology and anesthetic management in cats with diaphragmatic hernia are discussed.

Acute Kidney Injury↗