Masui. The Japanese journal of anesthesiology
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An epidural catheter was inserted at the T10-11 interspace for the treatment of acute herpetic pain in a 68-year-old woman. Loss of resistance method with saline was used for identifying the epidural space. After negative aspiration test for cerebrospinal fluid and blood, continuous epidural infusion of 0.2% ropivacaine 2 ml x hr(-1) with intermittent injections of 1% mepivacaine 3 ml was performed for 20 days without side effects. ⋯ The symptoms and signs suggested subdural block. Migration of the epidural catheter into the subdural space may have occurred. Subdural block may occur even if the catheter is initially properly placed in the epidural space.
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Although most cesarean sections are done under spinal anesthesia, we often experience severe hypotension. Fluid resuscitation is usually carried out for prevention of hypotension, but it is difficult to assess the suitable infusion volume. We examined whether the urine specific gravity can predict hypotension after spinal anesthesia for cesarean section. ⋯ We concluded that it was difficult to predict hypotension by using urine specific gravity because the correlation was too weak.
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A 22-year-old muscular karate player was diagnosed to have a tracheal tumor with a diameter of 2.8 cm that existed 2 cm under the glottis and occupied 60% of his trachea. He was scheduled for trachea resection and construction surgery. After awake-fiber intubation, anesthesia was maintained by continuous infusion of propofol and remifentanil, together with thoracic epidural anesthesia (T4-5). ⋯ It took almost 10 minutes to stop shivering completely, and the patient became too sedated and required noninvasive positive pressure ventilation overnight. We speculate that intraoperative remifentanil infusion induced severe shivering in this case. Shivering after remifentanil infusion can be a fatal complication in tracheal resection and construction surgery, especially in muscular patients.
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Vocal cord synechia causes respiratory disturbance and severe pneumonia. A 63-year-old woman with recurrent laryngeal nerve paralysis caused by translaryngeal intubation after resection of acoustic tumor and by thyroid surgery in her history and progressive dyspnea, had received vocal cord synechiotomy under general anesthesia. Preoperative endoscopic examination revealed edematous larynx, immobility of left unilateral vocal fold, insufficient mobility of right vocal fold, left arytenoid cartilage dislocation and a posterior glottic adhesion. ⋯ Trachea was cannulated immediately after incision of the scar under indirect video laryngoscopy. Vocal cord synechiotomy was completed without any respiratory complication. The case indicated that recurrent laryngeal nerve paralysis has a potential for vocal cord synechia and difficulty of tracheal intubation, and visibility of the surgical field among anesthesiologists and surgeons by indirect video laryngoscopy for vocal cord synechiotomy contributes to establish prompt surgical manipulation and tracheal intubation as to vocal cord synechiotomy.
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The case of a patient who might have developed nasogastric tube syndrome at the end of anesthesia is presented. A 62-year-old woman was scheduled for a general anesthesia with fiberscopic oro-tracheal intubation because of a predicted difficult airway. After the smooth and gentle intubation without any trauma and injury, a nasogastric tube was inserted blindly. ⋯ Extubation was cancelled and the patient was moved to an intensive care unit for respiratory management. On the next day, fiberscopic observation revealed a complete recovery and the endotracheal tube was removed without any difficulty. We strongly suspected the pharyngeal injury as acute nasogastric tube syndrome and an attention to this rare complication is required by anesthesiologists.