Edorium Journal of

Anesthesia

 
     
Case Report
 
Delayed neurologic sequelae following anoxic-anoxia related to nitrous oxide by pipeline mix-up during anesthesia
Jaouad Laoutid1, Nabil Jbili1, Lotfi Bibiche1, Hicham Kechna1, Moulay Ahmed Hachimi1
1Anesthesiology department, Military Hospital Moulay Ismail, Meknes, Morocco, Faculty of medicine and pharmacy, University Sidi Mohamed Ben Abdellah, Fes Morocco
Article ID: 100013A05JL2017
doi:10.5348/A05-2017-13-CR-2

Address correspondence to:
Jaouad Laoutid
Anesthesiology department, Military Hospital Moulay Ismail, Meknes, Morocco,
Faculty of medicine and pharmacy, University Sidi Mohamed Ben Abdellah
Fes Morocco

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How to cite this article
Laouad J, Jbili N, Bibiche L, Kechna H, Hachimi MA. Delayed neurologic sequelae following anoxic-anoxia related to nitrous oxide by pipeline mix-up during anesthesia. Edorium J Anesth 2017;3:7–11.


ABSTRACT
Introduction: Pipeline mix-up is a rare situation in anesthesia and may engender hypoxic event with severe complications. Delayed neurologic sequelae may appear after anoxic and or ischemic event. We report a case of delayed neurologic sequelae following prolonged anoxia related to nitrous oxide after pipeline mix-up in a newly operation room.
Case Report: A 36-year-old female, the first patient admitted for abdominoplasty under general anesthesia in a newly opened operating room. The patient was exposed to hypoxia-anoxia for several minutes due to crossing of oxygen and nitrous oxide pipelines. Nitrous oxide became the drive gas on anesthesia machine. The diagnosis of pipeline mix-up was unthinkable and delayed because of oxygen analyzer on anesthesia machine was non functional. The gas analyzer was very useful to suspect the pipeline mix-up when it showed 99% of inhaled fraction of nitrous oxide while anesthesia machine was set to deliver 100% oxygen. After complete recovery, she presented at the second postoperative day a paraparesis and dysarthria. Nitrous oxide myelopathy was eliminated because of normal vitamin B12 and homocysteine and delayed neurological sequelae (DNS) were retained. The patient has fully recovered under supratherapeutic dose of vitamin B12 therapy.
Conclusion: In a newly opened operation room, gas pipelines should be verified before beginning any anesthetic procedure. Our finding suggests that vitamin B12 may have a place in the treatment of delayed neurological sequalae.

Keywords: Delayed neurologic sequelae,General anesthesia, Nitrous oxide, Pipeline mic-up, Vitamin B12,


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Author Contributions
Jaouad Laoutid – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Nabil Jbili – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Lotfi Bibiche – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hicham Kechna – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Moulay Ahmed Hachimi – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Jaouad Laoutid et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.




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