Masui. The Japanese journal of anesthesiology
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Case Reports
[Successful fiberoptic tracheal intubation via Cobra PLA in a patient with an epiglottic tumor].
A 59-year-old woman with an epiglottic tumor was scheduled for the total removal of the mass by laryngomicrosurgery. The patient had no preoperative respiratory symptoms. ⋯ Post-extubation course was uneventful. The Cobra PLA can be a good alternative supraglottic airway device allowing easy tracheal intubation for difficult airway.
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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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Fade of the muscle contraction evoked by indirect tetanic nerve stimulation shows residual neuromuscular block. Anticholinesterases can reverse the partial block; however, they may also inhibit normal neuromuscular transmission and can cause fading responses by misuse of these drugs. The aim of this study is to investigate how neostigmine acts on normal neuromuscular function. ⋯ Therapeutic doses of neostigmine administered during normal neuromuscular function cause fade of the repetitive muscle contractions. Neuromuscular monitoring should be used before the reversal with neostigmine.
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A 72-year-old woman, ASA physical status II, weighing 47 kg, with uterine cancer was scheduled for semiradical hysterectomy. She had uncontrolled diabetes mellitus with FBS 123 mg x dl(-1) and HbA1c 7.0%. After an epidural catheter had been placed at the L1-2 level, general anesthesia was induced with propofol 100 mg, fentanyl 50 microg and vecuronium 5 mg. ⋯ Magnetic resonance angiography (MRA) on the 10th postoperative day demonstrated the obstruction of the right superficial femoral artery and anterior tibial artery. Emergent fasciotomy is the recommended treatment for severe compartment syndrome. Early recognition, diagnosis, and surgical intervention averted potential neural and functional impairment in this patient.
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A 76-year-old man underwent transurethral resection of bladder tumor under spinal anesthesia. Preoperative laboratory date showed normal platelet count (188,000 x microl(-1)) and normal coagulation profile (PT 11.4 sec, APTT 35.1 sec). Lumbar puncture was successfully performed at the L3-4 intervertebral space using a 27-gauge spinal needle with some technical difficulties. ⋯ On the 6th postoperative day, magnetic resonance image (MRI) showed a large epidural hematoma from L1 to L4. On the 13th postoperative day, the subjective symptoms disappeared and MRI on the 17th postoperative day revealed the absence of the hematoma. We should keep in mind that epidural hematoma as well as TNS can occur after spinal anesthesia even with a very fine needle.