Masui. The Japanese journal of anesthesiology
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Epidural anesthesia and spinal anesthesia are very popular anesthetic techniques used for surgery in elderly patients. Aging i s associated withanatomical changes and a loss of functional reserve in all organ systems. ⋯ However, previous studies have demonstrated only a slight effect of age on the anesthetic levels as well as the reduction in functions with these blocks. In elderly patients, both anesthetic techniques have been shown to decrease intraoperative blood loss, perioperative cardiac ischemic events, post-operative hypoxic episodes and arterial and venous thrombosis, and so forth.
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A 26-year-old woman with ovarian tumor underwent bilateral oophorectomy. Pre-operative examination showed massive ascites, obvious edema of the lower extremities and absence of pleural effusion. Immedi- ately after removal of massive ascites during the operation, sudden deterioration of SpO2 appeared. ⋯ After the operation we recognized left sided massive pleural effusion on the chest X-ray picture, and we drained it. However, the next day we recognized right side massive pleural effusion. We suspect that the fluid pooled in the lower extremities shifted to produce pleural effusion for some reason or other.
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Case Reports
[Pulmonary embolism induced by evacuator during transurethral resection of the prostate].
A 79-year-old man was scheduled to undergo transurethral resection of the hypertrophied prostate during general anesthesia. Anesthesia was maintained with sevoflurane 0.5-1.0% and nitrous oxide 50% in oxygen mixture. Immediately after using an evacuator to remove small resected pieces of the prostate, end-tidal carbon dioxide pressure (EtCO2) decreased suddenly from 31 mmHg to 18 mmHg. ⋯ The EtCO2, blood pressure, and oxygen saturation improved in about 20 minutes after the initial decrease of the EtCO2 had been detected. Thereafter, surgical procedure was done uneventfully. In routine anesthetic management of transurethral surgery, it should be considered that the sudden deterioration in vital signs may have been caused by evacuator used.
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Tracheobronchopathia osteochondroplastica is a rare benign disease, with difficult airway for intubation because the trachea and bronchia are narrow and transformed. We experienced one lung ventilation for a patient with the lung cancer associated with the tracheobronchopathia osteochondroplastica. ⋯ We could actually manipulate the blocker balloon very easily and maintain complete one lung ventilation maintaining SpO2 well. Coopdech bronchial blocker is useful for one lung ventilation in a patient with difficult airway such as tracheobronchopathia osteochondroplastica.