Journal of anesthesia
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Journal of anesthesia · Dec 2016
Case ReportsMitral valve repair facilitated with transapical beating heart NeoChord implantation in a non-Hodgkin's lymphoma patient.
Elderly patients with severe hematological malignancies may require cardiac surgery. The combined impact of cardiopulmonary bypass (CPB) and surgical trauma is a potent inflammatory activator and is increased by intraoperative and postoperative complications. ⋯ We report here the case of a 78-year-old male with B-cell non-Hodgkin's lymphoma, who presented with severe mitral regurgitation. The patient was successfully treated with the TOP-MINI procedure.
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Journal of anesthesia · Dec 2016
Case ReportsBiphasic cuirass ventilation for treatment of an air leak after pneumothorax in a patient with nemaline myopathy: a case report.
We describe an 11-year-old boy with nemaline myopathy who developed tension pneumothorax while undergoing noninvasive positive-pressure ventilation (NIPPV). The patient developed a persistent air leak after pleurodesis with minocycline hydrochloride and lowering of the NIPPV inspiratory pressure. ⋯ The air leak was resolved without any additional treatment. We should provide BCV for patients in whom surgery may have a risk of both extubation failure and postoperative complications before deciding on surgery.
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Journal of anesthesia · Dec 2016
A sequential anesthesia technique for surgical repair of unilateral vocal fold paralysis.
Thyroplasty with arytenoid adduction, a combined procedure for treatment of unilateral vocal fold paralysis, is typically performed under local anesthesia with sedation to allow for intraoperative voice assessment. However, the need for patient immobility and suppression of laryngeal responses to surgical manipulation can make sedation-analgesia challenging. We describe our first 26 consecutive cases undergoing thyroplasty and arytenoid adduction with a standardized technique consisting of a combination of general anesthesia with tracheal intubation followed by sedation-analgesia. ⋯ Extubation occurred without coughing, bucking, or agitation in 96 % of patients. All the patients were able to phonate appropriately and remained comfortable after emergence. This technique allowed improved surgical conditions with reduced patient discomfort and may be advantageous for other laryngeal and neck surgeries in which intraoperative patient feedback is required.
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Journal of anesthesia · Dec 2016
Case ReportsContinuous spinal labor analgesia for two deliveries in a parturient with severe subvalvular aortic stenosis.
Various degrees of left ventricular outflow tract (LVOT) obstruction have been seen in patients with subvalvular aortic stenosis (SAS). Regional analgesia during labor for parturients with SAS is relatively contraindicated because it has a potential risk for hemodynamic instability due to sympathetic blockade as a result of vasodilation by local anesthetics. We thought continuous spinal analgesia (CSA) using an opioid and minimal doses of local anesthetic could provide more stable hemodynamic status. ⋯ There were no fluctuations in her hemodynamics. Although her SAS in her second pregnancy was more severe than in the first, her hemodynamics exhibited less fluctuation during the second delivery with this method. In conclusion, CSA using fentanyl combined with minimal doses of bupivacaine provided satisfactory analgesia and stable hemodynamics in parturient with severe SAS.
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Journal of anesthesia · Dec 2016
No association of labor epidural analgesia with cerebral palsy in children.
Some pregnant women avoid labor epidural analgesia because of their concerns about risk of cerebral palsy in children. Although it is believed that labor epidural does not contribute to cerebral palsy, to our knowledge no study has been published to specifically address this concern. We carried out a retrospective case-control study to investigate whether labor epidural analgesia is associated with cerebral palsy in children. ⋯ We found no association between the use of labor epidural analgesia and the occurrence of cerebral palsy in children.