Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Mar 2008
Case ReportsProtection against large-volume regurgitated fluid aspiration by the ProSeal laryngeal mask airway.
The ProSeal laryngeal mask airway (PLMA) is designed to protect the airway from regurgitated fluid. However, successful channeling of large volumes of regurgitated fluid by PLMA is rarely reported. This case report states that a large volume of regurgitated fluid was successfully channeled by a PLMA. ⋯ The patient underwent fistula repair a week later and was discharged without further difficulty. This is a unique clinical case report to show PLMA can be effective in preventing aspiration when massive passive regurgitation occurs. Strategies in the management of massive regurgitation during PLMA use are discussed.
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Acta Anaesthesiol Taiwan · Mar 2008
Case ReportsThoracic epidural anesthesia for a polymyositis patient undergoing awake mini-thoracotomy and unroofing of a huge pulmonary bulla.
General anesthesia with one-lung ventilation is a conventional anesthetic strategy for most chest surgery, including resection of pulmonary bullae. However, this anesthetic management may cause alveolar barotrauma, hemodynamic instability, pulmonary atelectasis and long-term ventilator dependency. ⋯ There were no perioperative complications, and the patient was satisfied with the anesthetic care. Pulmonary function tests and daily physical performance also improved postoperatively.
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Acta Anaesthesiol Taiwan · Dec 2007
Case ReportsAnesthesia for cesarean section in a parturient with acute pulmonary edema--a case report.
Pulmonary edema is a rare complication in preeclampsia patients without pre-existing cardiac disease, tocolytic therapy, infection, or multiple gestations. We present a preeclamptic patient complicated by overwhelming pulmonary edema just prior to cesarean section and the massive edematous fluid production made it an exceptional challenge to the anesthesiologist on airway management. Emergent classic laryngeal mask airway (cLMA) placement was an effective alternative means for ventilation to provide temperate oxygenation in this case.
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Acta Anaesthesiol Taiwan · Dec 2007
Case ReportsAnesthesia for emergency cesarean section in a parturient with undiagnosed acute fatty liver of pregnancy--a case report.
Few clinical diagnoses of acute fatty liver of pregnancy (AFLP) are established immediately upon admission, while anesthetic interventions are frequently required on an emergent basis. We report a patient with the admitting diagnosis of severe preeclampsia with fetal distress necessitating an emergency cesarean section. An epidural block was instituted before laboratory data were available. ⋯ The peripartum anesthetic care of the pregnant woman is presented. AFLP was confirmed by liver needle biopsy 26 days later. Taking our case as an examplification, clinicians must have a high suspicion that AFLP may exist in concurrence with preeclampsia when a parturient presents manifestations of nausea, jaundice, elevated bilirubin, elevated liver enzyme activities, prolonged PT and PTT, or thrombocytopenia.
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Acta Anaesthesiol Taiwan · Dec 2007
Risk factors affecting adverse outcomes of cardiac surgery in patients aged 70 years and older.
The elderly segment of the population in Taiwan is increasing rapidly. According to the latest information from the Directorate-General of Budget, Accounting and Statistics, Executive Yuan, Taiwan, 1,553,367 civilians of the total population of 22,879,510 (6.8%) are seventy years old and older in 2007. The proportion of high-risk patients has increased dramatically owing to a greater number of elderly patients and increased number of average patients with heart diseases presenting for cardiac surgery. We analyzed the preoperative risk factors for in-hospital mortality, morbidity and the likelihood of prolonged intensive care unit (ICU) stay in elderly patients after cardiac surgery. ⋯ The perioperative risk of cardiac surgery increases in older patient groups, and some risk factors have different influences on mortality, morbidity and ICU stay. Risk assessment in older cardiosurgical patients with convenient risk factors helps the clinicians to apply rational and cost-effective treatment strategies into practice.