Masui. The Japanese journal of anesthesiology
-
We report here a case of upper airway obstruction occurring after extubation in a 55-yr-old 60 kg man after elective nephrectomy. Anesthesia was maintained with O2 (33%), N2O, sevoflurane (1.5-2%), and propofol infusion (2 mg x kg(-1) x hr(-1)). Blood loss was 1,965 ml, part of which was substituted by blood transfusion and albumin infusion. ⋯ Subsequent investigations using a fiberscope confirmed extensive soft tissue swelling, maximal at the level of the vocal cord and extending up- and down-wards to the trachea, indicating that the obstruction is caused by severe laryngeal edema. We believe that edema may have been caused by hypoalbuminemia (1.3 g x dl(-1)) at the end of operation. Therefore, it should be noted that hypoalbuminemia may cause laryngeal edema leading to acute airway obstruction.
-
We report a case of severe intraoperative pulmonary edema during living related liver transplantation (LRLT) surgery. A 60-year-old woman with end-stage primary biliary cirrhosis underwent LRLT. ⋯ Further deterioration of hypoxemia was observed after reperfuion of the portal vein. We conclude that this severe pulmonary edema was caused by transfusion related acute lung injury, and prolonged ahepatic phase with reperfusion injury deteriorated the lung condition.
-
Rapid mobilization and rehabilitation after CABG has a potential benefit of reducing both costs and pulmonary complications (such as atelectasis and pulmonary embolism). Moreover, it improves the patient's emotional recovery. We performed fast-track cardiac anesthesia aiming toward early rehabilitation. ⋯ We can safely manage fast-track cardiac anesthesia and perioperative management aiming toward early rehabilitation after CABG surgery.
-
An eight-year-old boy with Cornelia de Lange syndrome underwent left inguinal hernioplasty and orchiopexy under general anesthesia. The patient with Cornelia de Lange syndrome had severe primordial growth failure with muscle-skeletal system such as cleft palate, micrognathia, and micromelia of the extremities and mental retardation as well as characteristic faces such as deep supercilia, etc. We suspected difficulty of endotracheal intubation due to this syndrome. ⋯ Anesthesia was maintained uneventfully by bolus intravenous injection of ketamine 5 mg and inhalation of oxygen and sevoflurane 2-3% with mechanical ventilation. The anesthetic management in a patient with Cornelia de Lange syndrome should be carried out with careful preoperative evaluation of physical status, and especially the difficult endotracheal intubation should be kept in mind. Induction of general anesthesia with injection of ketamine followed by inhalation of sevoflurane without muscle relaxant is a safe method in Cornelia de Lange syndrome.
-
Postoperative care following ambulatory surgery is done at home. Therefore, it is important to establish qualitative clinical discharge criteria that can be used to determine when patients can go home safely for the care by friend or relative. ⋯ A discharge scoring system is effective to determine the optimal length of stay in the ambulatory surgery unit and to achieve the prompt and safe discharge of patients. In order to popularize ambulatory surgery and reduce admission rate, it is necessary for us to make an effort to change patients' mind for ambulatory surgery.