Masui. The Japanese journal of anesthesiology
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Vocal cord paralysis after tracheal intubation is rare. It causes severe hoarseness and aspiration, and delays recovery and discharge. Arytenoid cartilage dislocation and recurrent nerve paralysis are main causes of vocal cord paralysis. ⋯ In pediatric cardiac surgery, vocal cord paralysis occurs in 1 (0.1-0.5%) of 200-1,000 patients. We classified the severity of vocal cord paralysis as I, severe hoarseness; II, aspiration or dysphagia; and III, bilateral vocal cord paralysis, aspiration pneumonia, or the need for tracheal re-intubation or tracheotomy. We discuss the importance of informed consent for the patient and family.
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Case Reports
[A case of impossible ventilation after induction of anesthesia in a patient with massive nasal bleeding].
We report a case of impossible ventilation in a patient with severe nasal bleeding. A 47-year-old man with intractable nasal bleeding was scheduled for emergent hemostasis under general anesthesia. He also had alcohol-related cirrhosis and was highly obese (165 cm, 93 kg). ⋯ Mask ventilatidn was impossible even after oral suctioning. We intubated the trachea with the Macintosh laryngoscope and suctioned blood from the trachea; SpO2 gradually improved and the trachea was washed with a large amount of normal saline. The patient was transferred to the intensive care unit and extubated uneventfully on day 3 postoperatively.
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Anesthetic management for cesarean section of patients with placenta previa accreta is challenging. The aim of this retrospective study was to review past placenta previa accreta cases in our hospital to propose a better strategy for anesthetic management for this difficult condition. ⋯ The present retrospective study showed that stepwise treatment and using IABO could be an effective aid for management of plasenta previa accreta. It is necessary to compare the effectiveness of IABO with that of common iliac artery occlusion in reducing the amount of blood loss.
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Blocking conduction in the saphenous nerve is important in providing surgical anesthesia of the lower leg. The aim of this retrospective study was to determine the efficacy of ultrasound-guided paravenous approach for saphenous nerve block. ⋯ Paravenous approach for saphenous nerve block may be effective particularly with limited resources.
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Case Reports
[Successful sedation with landiolol and dexmedetomidine during spinal anesthesia in a patient with active dementia].
We report a successful case of sedation during spinal anesthesia using continuous administration of landiolol and dexmedetomidine in a patient with severe dementia. An 86-year-old man weighing 63 kg with severe dementia and chronic obstructive pulmonary disease was scheduled for emergent open reduction of fracture under spinal anesthesia. On admission, he presented with delirium as a result of pain and environmental change. ⋯ After 10 minutes, he was sedated and agreed to undergo spinal anesthesia. Spinal anesthesia was successful with isobaric bupivacaine 3.0 mI. The patient showed no untoward behavior during anesthesia and the operation.