Masui. The Japanese journal of anesthesiology
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We anesthetized three patients with refractory atrial fibrillation undergoing the new thoracoscopic mini Maze procedure. This minimally invasive surgical procedure provides isolation and ablation of the bilateral pulmonary vein without thoracotomy or cardiopulmonary bypass, which was performed first in the United States in 2003. General anesthesia was administrated with a double lumen tracheal tube for bilateral single lung ventilation, and epidural anesthesia was also administrated. ⋯ Another patient was complicated with dextrocardia, but the procedure was successful. One other patient had no complications and the procedure was performed as planned. Certain anesthetic management is essential for this new procedure and we have to prepare for any predictable events.
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Randomized Controlled Trial
[Combined intrathecal morphine and bupivacaine for elective post-caesarean pain].
Intrathecal morphine is widely used for analgesia following cesarean section in Europe and North America. In Japan analgesic method of intrathecal morphine was admitted to the insurance adjustment and it is necessary to study optimal dose of the morphine. ⋯ It is concluded that intrathecal morphine 0.1 mg gives effective analgesia with minimum side effects after cesarean section for the Japanese patients.
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Case Reports
[Two cases of transfusion-related acute lung injury following massive transfusion during the perioperative period].
Transfusion-related acute lung injury (TRALI) is a serious complication of transfusion of blood and blood components. TRALI is reported to be the most common cause of transfusion-associated death. TRALI has increasingly become known in the medical community. ⋯ We report two cases of TRALI after massive transfusion due to massive bleeding during cardiovascular surgery. In the perioperative period, the diagnosis of TRALI is difficult to make because of coexistence of various factors leading to hypoxia. Thus, in this report, we discuss the management of these two cases focusing upon the differential diagnosis of TRALI.
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We report a case of grand mal convulsion due to inadvertent intravascular injection of ropivacaine. An 83-year-old woman was scheduled for upper limb surgery. The interscalene block was performed with neurostimulator and 0.5% ropivacaine 30 ml was injected after careful negative aspiration. ⋯ Although careful aspiration was done before the injection of ropivacaine, inadvertent intravenous injection could have occurred during the administration. Intermittent aspiration should be indispensable during the administration, because a large dose of local anesthetic is necessary for interscalene block. In this case, the only cardiovascular manifestation was ventricular premature beats indicating that ropivacaine has less cardiotoxicity.
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Case Reports
[Difficult mask ventilation and tracheal intubation in a patient with Hutchinson-Gilford syndrome].
We report a case of difficult ventilation and tracheal intubation in a 18-year-old woman with Hutchinson-Gilford syndrome. She was diagnosed with osteosarcoma in the right tibia and thyroid cancer. ⋯ In the second operation, mask ventilation and tracheal intubation were easily conducted by using Berman pharyngeal airway. Berman airway was useful for airway managemant of Hutchinson-Gilford syndrome.