Journal of anesthesia
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Journal of anesthesia · Jan 2009
Case ReportsLife-threatening spontaneous hemothorax in a patient with thrombotic thrombocytopenic purpura.
Spontaneous hemothorax in the left pleural space occurred suddenly in a patient with thrombotic thrombocytopenic purpura (TTP). In spite of massive blood transfusion, the hemorrhage could not be stopped. The patient suffered shock due to tension hemothorax and hypovolemia, resulting in cardiac arrest. ⋯ The main cause of the bleeding was rupture of the left intercostal vein. TTP is a severe microvascular occlusive thrombotic microangiopathy that can induce congestion, vasculitis, and ischemia. This mechanism is thought to have been involved in the rupture of the intercostal vein in the present patient.
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Journal of anesthesia · Jan 2009
Effect of posture on mouth opening and modified Mallampati classification for airway assessment.
Several bedside airway assessment methods have been proposed for preoperatively identifying patients who are difficult to intubate. To date, the Mallampati grading remains a time-tested technique for difficult airway assessment. Both Mallampati and the further modification by Samsoon and Young assessed patients in the seated position. ⋯ Eighty adult patients of American Society of Anesthesiologists (ASA) physical status I and II, aged 18-65 years, admitted to our neurosurgical ward were enrolled and assessed for airway. Our study revealed that change in posture produced a significant change in the mouth openings and Mallampati grades of the patients. This change was always toward a higher grade when the patient was turned supine from the sitting position.
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Journal of anesthesia · Jan 2009
Case ReportsDifficult laryngoscopy caused by massive mandibular tori.
Mandibular tori, defined as bony protuberances located along the lingual aspect of the mandible, are a possible cause of difficult intubation. We describe a case of mandibular tori that resulted in difficult intubation. A 62-year-old woman who had speech problems was diagnosed with mandibular tori, and was scheduled for surgical resection. ⋯ The massive tori prevented insertion of the tip of the blade into the oropharynx, and neither the epiglottis nor the arytenoids could be visualized, i.e., Cormack and Lehane grade IV. Blind nasotracheal intubation was successful and the surgery proceeded uneventfully. The anesthesiologist should examine any space-occupying lesion of the oral floor and should be vigilant for speech problems in order to detect mandibular tori that might impede intubation.
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Journal of anesthesia · Jan 2009
Case ReportsSuccessful extracorporeal membranous oxygenation for a patient with life-threatening transfusion-related acute lung injury.
A case of transfusion-related acute lung injury (TRALI) that was successfully treated with extracorporeal membranous oxygenation (ECMO) is reported. A 58-year-old male patient underwent hepatectomy, and pulmonary edema occurred after the administration of fresh-frozen plasma and packed red cells. In the postoperative period, the impaired oxygenation progressively worsened, resulting in life-threatening hypoxemia, despite vigorous treatments. ⋯ As a treatment for ARDS, ECMO does not cure the underlying disease of the lungs, however, with ECMO, TRALI, usually improves within 96 h with respiratory support. ECMO for TRALI-induced lethal hypoxemia is useful for providing time to allow the injured lung to recover. It is suggested that ECMO might be a useful option for the treatment of TRALI-induced, potentially lethal hypoxemia.
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Journal of anesthesia · Jan 2009
Acid-base variables in patients with acute kidney injury requiring peritoneal dialysis in the pediatric cardiac care unit.
We aimed to clarify the acid-base abnormalities of patients with acute kidney injury (AKI) requiring peritoneal dialysis (PD) in pediatric cardiac care units. ⋯ Patients with AKI requiring PD in a pediatric cardiac care unit had significant metabolic acidosis compared to controls matched by the type of surgery and body weight. Hyponatremia and hypoalbuminemia were characteristics of these patients. The calculated SIDa was smaller in the PD than in the control group. Only the serum albumin had a significant prognostic value.