Masui. The Japanese journal of anesthesiology
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Case Reports
[Use of Airwayscope with pediatric intlock in a patient with first and second branchial arch syndrome].
First and second branchial arch syndrome is a congenital anomaly of craniofacial dysplasia involving organs derived from the second branchial arch. The main characteristics are microtia and mandibular hypoplasia. A 6-year-old boy was scheduled for adenoidectomy and bilateral myringotomy and tube placement. ⋯ Control of the bronchoscope consequently became easy We successfully guided it to his glottis and performed tracheal intubation. His condition was stable during the procedure. In conclusion, we safely performed tracheal intubation in a patient with first and second branchial arch syndrome using the AWS and a fiberoptic bronchoscope.
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Case Reports
[Three successful cases of relieved abdominal fullness by thoracic epidural analgesia].
We report three successful cases of treating intractable abdominal fullness associated with cancer by continuous thoracic epidural analgesia. Case 1 was a 31-year-old woman with sarcoma of the uterus suffering from back and epigastric pain; abdominal fullness was treated by continuous epidural analgesia with ropivacaine and morphine. After epidural analgesia, symptoms disappeared and removal of ascites was unnecessary. ⋯ She also suffered from abdominal fullness due to meteorism caused by intestinal hypomotility by cancer invasion to the spine. Thoracic epidural analgesia effectively treated cancer pain and reduced abdominal fullness, allowing her to continue hospital visits. Our findings suggest that epidural analgesia may effectively treat opioid-resistant intractable abdominal fullness.
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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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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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Aortocaval fistula is a rare complication of ruptured abdominal aortic aneurysm. We report anesthetic management of a patient with aortocaval fistula caused by rupture of a huge abdominal aortic aneurysm into the inferior vena cava. A 51-year-old man who had complained of low back pain and general fatigue was referred to our hospital because of his liver damage. ⋯ After the repair of the aortocaval fistula, the hemodynamics became stable. The patient had a high output but a good cardiac function in preoperative examination. Therefore anesthesia was managed successfully without worsening high-output heart failure.