Masui. The Japanese journal of anesthesiology
-
Case Reports
[Case of spinal anesthesia for pyrolomyotomy in a former preterm infant with chronic lung disease].
A former premature infant (1,795 g) with chronic lung disease underwent pyrolomyotomy under spinal anesthesia. She had been managed with artificial ventilation for 2 months after birth and had developed chronic lung disease. She showed frequent apnea with desaturation several times per day and 21 x min(-1) of oxygen had been administered. ⋯ After we confirmed the anesthesia level up to T5, surgery was commenced. She was managed with mask CPAP to prevent deasaturation under spontaneous respiration during surgery. She required nasal-CPAP to prevent apnea after surgery and she was transferred back to the referred hospital on the 3rd postoperative day without any sequela.
-
We describe the use of an abdominal aortic occlusion balloon catheter to control excessive blood loss at cesarean hysterectomy for placenta accreta. Prophylactic abdominal aortic occlusion balloon catheter was placed in the angiography suite under local anesthesia before surgery. The 38-year-old parturient was anesthetized with propofol, sevoflurane, ketamine, remifentanil and fentanyl under close monitoring and appropriate respiratory management. ⋯ Intraoperative blood loss was 1,800 g, and 300 g of autologous blood and 4 units of red cell concentrates were transfused. The postoperative course was uneventful. The present case suggests that prophylactic insertion of an aortic occlusion balloon catheter seems to be a safe and an effective method in controlling anticipated bleeding for caesarean hysterectomy in a parturient with placenta accreta.
-
With the expanding elderly population in Japan, general anesthesia in patients above 80 years of age has become routine and is increasing. We report on a case of general anesthesia for a 100-year-old woman with chronic heart failure. ⋯ There was no cardiopulmonary instability during the operation, but heart failure became worse postoperatively, and it took nearly a month before the patient could leave the hospital. As for the operation and general anesthesia in the elderly, it is important not only to assess their perioperative physical risks but also to consider family background and postoperative course.
-
Case Reports
[Case of airway management by laryngeal mask airway for a child with laryngeal web undergoing adenotonsillectomy].
We report a case of airway management by laryngeal mask airway (LMA) for a 4-year-old boy with laryngeal web undergoing adenotonsillectomy. Although the patient had no symptoms of airway stenosis, we detected a subglottic laryngeal web during the preoperative examination. The opening orifice of the laryngeal web was estimated to be too small for intubation, and we chose to manage the airway with LMA and spontaneous respiration. Using the LMA and Davis-Crowe mouth gag, we were able to provide the surgeon with the same exposure as with intubation while effectively managing the airway.
-
Hemorrhage is the leading cause of maternal death. Pregnant woman can tolerate a larger amount of blood loss than non-pregnant woman, but obstetric hemorrhage is characterized by a high incidence of coagulopathy. The Japanese Society of Anesthesiologists and four related academic societies published "Guidelines for management of critical bleeding in obstetrics" in April 2010. ⋯ Declaration of an emergency is also essential for calling supportive medical personnel. To deal rapidly with critical bleeding, hospital actions to be taken should be prepared, and simulation exercise should be performed to correct inappropriate actions prior to an actual crisis. A systematic, not individual, approach is required to save the life of a bleeding pregnant woman.