A&A practice
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Cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy (HIPEC) present a challenging task for anesthesia providers. Anesthesia management may be complicated by hyperthermia, fluid shifts, and distinct inflammatory response. ⋯ We report a case of a 2-year-old child with a relapse of an alveolar rhabdomyosarcoma of the uterus and peritoneal carcinomatosis treated with CS and HIPEC. For children, careful temperature measurement, intraoperative prevention of hyperthermia, and sufficient volume management are important, as well as postoperative pediatric intensive care with experience CS and HIPEC patients.
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A 78-year-old woman complained of numbness, tingling, and pain in the left leg 6 months after greater saphenous vein stripping. Ultrasonography identified a mass adjacent to the saphenous nerve at the scar. Ultrasound-guided hydrodissection separated the mass from the nerve. ⋯ The visual analog pain scale decreased from 80 (before treatment) to 60 three days later. The hydrodissection was repeated weekly for a total of 8 times, and the pain completely resolved 4 months later. Ultrasound-guided hydrodissection is effective to treat nerve entrapment after lower extremity varicose vein stripping.
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Tracheostomy is a weaning technique in patients requiring prolonged ventilation. During this period, complications like tube blockage, fracture of the tracheostomy tube, or cuff rupture can occur. Fracture of the tracheostomy tube can result in the distal end of the tube being dislodged further down the trachea, leading to airway obstruction and hypoxia. We report fracture of a tracheostomy tube in which the distal end was removed, using the inflation line of the pilot balloon to pull out the broken end of the tracheostomy tube.
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Tracheobronchomalacia is a weakness of the trachea and bronchi due to abnormal cartilage and muscular support leading to airway obstruction. We report a case of an adult former smoker without pulmonary symptoms who underwent robotic-assisted laparoscopic cystectomy in the steep Trendelenburg position. ⋯ Tracheomalacia is an underdiagnosed condition in patients with a smoking history and may mimic other obstructive diseases. The anesthesiologist should remain vigilant to the possibility of airway collapse in former smokers, specifically in cases of increased intrathoracic pressure.