Masui. The Japanese journal of anesthesiology
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Case Reports
[Anesthetic management of a morbidly obese patient undergoing laparoscopic right nephrectomy].
A 41-year-old man weighing 196 kg (body mass index of 62.5 kg m2) with renal cancer was scheduled for laparoscopic right nephrectomy. On the day before surgery, we confirmed the intraoperative patient position with the patient and medical staff to prevent neurological deficit during the intraoperative period. For postoperative analgesia and prevention of respiratory complications, an epidural catheter was inserted under radiography and ultrasound guidance. ⋯ During neumoperitoneum at 12 mmHg, mechanical ventilation was achieved without hypercapnia, hypoxia or elevated airway pressure, with rate of 12 min-1, FIO2 of 0.6, PIP of 25 cmH2O and PEEP of 8 cmH2O. The surgery was completed and his trachea was extubated in the operating room. He did not develop any perioperative complications and was discharged on the 10th day after the surgery.
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The first case was a 69-year-old woman with rheumatoid arthritis undergoing posterior occipito-cervical fusion. Although the operation was successfully performed, airway obstruction developed immediately after extubation. Her upper airway obstruction probably came from pharyngolaryngeal edema. ⋯ We used cricothyrotomy tubes (Mini-Trach II) in these two patients with postoperative upper airway obstruction and performed assist-ventilation via the tube. After starting ventilation through Mini-Trach II, we succeeded in intubation. We belive that cricothyrotomy in well-trained hands can be used safely for the management of the patient with a difficult airway.
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We recently encountered three cases of the leakage from the connecting portion of sevoflurane vaporizer in Fabius Tiro produced by Drager company, and in one case of those, oxygen saturation decreased. The connecting portion had leakage merely in the contact with the fixture of the monitor, because of the structure easily displaced by an external force. Further, it was difficult to detect the leakage due to the ability to correct the insufficient supply of fresh gas by taking in air. We hope a reform of the connecting portion and an alarm to inform it if the anesthesia machine detects the leakage.
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Although tracheal laceration during surgical procedure is a rare complication, it can be life-threating. Its immediate recognition and treatment are important. A 72-year-old man with aortic valve regurgitation was scheduled for aortic valve replacement. ⋯ Air leaks were no longer present. After surgical repair, the aortic valve replacement was performed. The postoperative courses of both tracheal laceration repair and aortic valve replacement were uneventful.
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Case Reports
[Prompt resuscitation by obstetric anesthesiologists saved a parturient with amniotic fluid embolism: a case report].
Amniotic fluid embolism (AFE) is a disorder with a high mortarity rate, because it often causes sudden respiratory failure, circulatory collapse and disseminated intravascular coagulation (DIC). We present a case of AFE in which an obstetric anesthesiologist promptly initiated resuscitation of a parturient and saved her without any sequelae. Her fetus was diagnosed as intrauterine fetal demise on 25th gestational week and vaginal delivery under epidural analgesia was planned. ⋯ This case was diagnosed as AFE with high serum sialyl-Tn antigen and zinc-coproporphyrin. The obstetric anesthesiologists are one of the best groups of physicans for resuscitation because they have skills in managing obstetric emergencies such as AFE. In this case, the crucial points for successful resuscitation were prompt obstetric anesthesiologist involvement and good communications with obstetricians and midwives.