Masui. The Japanese journal of anesthesiology
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A 78-year-old woman with low pulmonary function (forced expiratory volume in 1 second of 450 ml) underwent an open incisional pulmonary tissue biopsy for suspected diffuse panbronchiolitis and anti-neutrophil cytoplasmic antibody-associated vasculitis. She was intubated with a double-lumen tracheal tube after receiving 0.57 mg x kg(-1) of rocuronium and 0.9 mg kg(-1) of propofol. Under one-lung ventilation, the PaCO2 was 54-74 mmHg and PaO2 was 121-127 mmHg until 50 min after lung recruitment, after which the PaCO2 decreased to 62-66 mmHg and PaO2 increased to 283-382 mmHg. ⋯ Although the rocuronium-induced neuromuscular blockade was reversed by 2.0 mg x kg(-1) of sugammadex (train-of-four ratio, nearly 100%), it seemed a little difficult to extubate the patient just after the operation because blood gas analysis showed a pH 7.39, PaCO2 of 66 mmHg and PaO2 382 mmHg with FIO2 1.0. The blood gas analysis revealed pH 7.52, PaCO2 44.5 mmH and PaO2 144 mmHg with FIO2 of 0.4. The patient was successfully extubated with no respiratory complication 10 h after the end of the operation on the first postoperative day.
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We hypothesized that pre-operative BNP levels predict postoperative morbidity and mortality in patients undergoing non-emergent cardiac surgery. ⋯ Preoperative BNP predicted postoperative morbidity and mortality.
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We describe successful pain control in a patient suffering from severe pain, using an opioid combination of transdermal fentanyl and oral oxycodone. A woman in her 40s with a giant-cell tumor of the sacrum suffered from refractory 4-5/5 pain on the Wong-Baker faces pain rating scale in her sacrum, feet and legs. Despite administration of fentanyl (2,520 microg day(-1)), she could not sleep in the supine position due to pain and dysesthesia. ⋯ Hence, we reduced the oral oxycodone dose and began a combination of transdermal fentanyl and oral oxycodone in addition to increasing doses of pregabalin. With the combination of transdermal fentanyl (25 microg x hr(-1)) and oral oxycodone (60 mg x day(-1)) her pain decreased to 1-3/5 on the faces pain rating scale. Our experience suggests that an opioid combination may provide favorable pain control in patients with severe pain, while minimizing the side effects of each drug.
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Although shoulder-tip pain during cesarean section has been reported, little is known about this entity. We investigated the incidence of shoulder-tip pain in patients undergoing cesarean delivery under combined spinal-epidural anesthesia (CSEA). Next, we studied whether head-up position during surgery reduced the incidence of shoulder-tip pain due to prevention of the spread of blood and amniotic fluid from the subphrenic space. ⋯ This study showed that women undergoing cesarean section under CSEA experience shoulder-tip pain with great frequency. Head-up position during surgery decreases shoulder-tip pain during and after cesarean delivery. The results suggest that one of the causes of this pain is the presence of blood or amniotic fluid in the subdiaphragmatic region.
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A 12-year-old male patient with Coffin-Lowry syndrome was scheduled for posterior cervical decompression and fusion for cervical spinal injuries. The patient had features of Coffin-Lowry syndrome including mental retardation, prominent forehead, a short nose with a wide tip, a wide mouth with full lips, short stature, microcephaly, and kyphoscoliosis. We anticipated major troubles related to anesthesia such as difficult ventilation and intubation, communication difficulty during induction and extubation, and difficulty in using a naso-pharyngeal airway. ⋯ When the surgery was completed, we extubated using a tube introducer in the trachea. As we found that the patient's airway was open, we removed the introducer. In conclusion, with a thorough planning of the anesthetic management, we successfully managed anesthesia for cervical spinal surgery in a patient with Coffin-Lowry syndrome.