Korean journal of anesthesiology
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Korean J Anesthesiol · May 2012
Bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after percutaneous tracheostomy -A case report-.
We report a rare case of a 72-year-old female who developed extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, and pneumoretroperitoneum after a percutaneous dilatational tracheostomy. The patient's T-cannula was accidentally connected to the oxygen line with a non-perforated connector. The patient rapidly developed respiratory insufficiency and subcutaneous emphysema in the neck and both shoulders. ⋯ CT scans of the chest, abdomen, and pelvis revealed an extensive distribution of air throughout the chest and abdomen. The patient was treated successfully with supportive care. This case illustrates the rare occurrence of air passing into multiple body compartments, highlighting the potentially serious complications of a tracheostomy and the importance of intensive care during the recovery period.
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Korean J Anesthesiol · May 2012
Anesthesia for massive retrosternal goiter with severe intrathoracic tracheal narrowing: the challenges imposed -A case report-.
Anesthetic management of patients with mediastinal masses remains challenging as acute cardiorespiratory decompensation may follow induction of anesthesia. We describe a 57 year old lady with massive retrosternal goiter and severe intrathoracic tracheal compression who had a total thyroidectomy. Comprehensive contingency plans were an essential prerequisite for successful management of difficult airway, including multidisciplinary involvement of otorhinolaryngologic and cardiothoracic surgeons preparing for rigid bronchoscopy and cardiopulmonary bypass. ⋯ Surgical manipulation led to intermittent total tracheal compression and inadequate ventilation. The tumor was successfully removed via the cervical approach. A close working relationship between anesthesiologists and surgeons was the key to the safe use of anesthesia and uneventful recovery of this patient.
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Korean J Anesthesiol · May 2012
Efficacy and safety of a lidocaine/tetracaine medicated patch or peel for dermatologic procedures: a meta-analysis.
To justify the use of the lidocaine/tetracaine medicated patch or peel as a preventive treatment for reducing pain and discomfort in adults and children. We reviewed randomized controlled trials (RCTs) to evaluate the efficacy and safety of the lidocaine/tetracaine medicated patch or peel compared with placebo. ⋯ The lidocaine/tetracaine medicated patch or peel is a well accepted, effective and safe method for minor dermatologic procedures based on pooled data of trials in terms of adequacy of cutaneous anesthesia and adverse effects.
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Korean J Anesthesiol · May 2012
Fluoroscope guided epidural needle insertioin in midthoracic region: clinical evaluation of Nagaro's method.
In the midthoracic region, a fluroscope guided epidural block has been proposed by using a pedicle as a landmark to show the height of the interlaminar space (Nagaro's method). However, clinical implication of this method was not fully evaluated. We studied the clinical usefulness of a fluoroscope guided thoracic epidural block in the midthoracic region. ⋯ The fluorposcope guided epidural block by Nagaro's method was useful in the midthoracic region. However, further study for the caudal shift of needle entry point may be needed.
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Korean J Anesthesiol · May 2012
At therapeutic concentration bupivacaine causes neuromuscular blockade and enhances rocuronium-induced blockade.
Partially paralyzed patients may be placed in the risk of pharyngeal dysfunction. Bupivacaine acts as acetylcholine receptor ion channel blocker and may synergistically interact with rocuronium to augment NM blockade. Thus, this study aims to elucidate whether or not, at a therapeutic concentration, bupivacaine by itself may cause NM blockade and reduce an effective concentration of rocuronium. ⋯ Clinicians should be aware that bupivacaine by itself at its therapeutic concentration inhibit NM conduction and enhances rocuronium-induced muscle relaxation.