Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Dec 2006
Case ReportsIntraoperative pneumothorax during laparoscopic cholecystectomy.
Anesthesiologists currently view laparoscopic cholecystectomy resemblant to other laparoscopic procedures with respect to the necessity of inducing a pneumoperitoneum via abdominal insufflation of carbon dioxide (CO2). The present case report describes a healthy 63-year-old man who while undergoing elective laparoscopic cholecystectomy under general anesthesia, developed hypoxemia in the course in consequence of pneumothorax. This complication, although rare, can be catastrophic if prompt diagnosis and rapid intervention and management do not come in the nick of time.
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Acta Anaesthesiol Taiwan · Dec 2006
Case ReportsManagement of postdural puncture headache by epidural saline delivered with a patient-controlled pump--a case report.
Unintentional dural puncture is the most frequent cause of postdural puncture headache (PDPH) in epidural anesthesia and analgesia. Conservative treatments of PDPH include bed rest, oral analgesics, and hydration. ⋯ Many patients may refuse the procedure due to the risks involved. We describe a female patient who had her PDPH successfully treated with epidural saline delivered by a patient-controlled analgesia device (Abbott Pain Management-APM) without molestation of her daily activities.
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Acta Anaesthesiol Taiwan · Dec 2006
Case ReportsFiberoptic tracheal intubation through a classicial laryngeal mask airway under spontaneous ventilation in a child with Treacher Collins syndrome.
This report cites the usefulness of fiberoptic scope-guided endotracheal tube intubation through a classical laryngeal mask airway (LMA) during spontaneous breathing. Treacher Collins Syndrome (TCS) is a condition where airway management is stressful to anesthesiologists. We report a pediatric patient with TCS undergoing cleft palate repair. ⋯ Intubation by rigid laryngoscopy was unsuccessful at the first attempt. One month later, under spontaneous ventilation, tracheal intubation was smoothly performed with the use of a fiberoptic scope through an LMA under intravenous anesthesia with propofol. Fiberoptic scope-guided endotracheal intubation through an LMA with the push of another ETT of the same size to curb the back slippage of the endotracheal tube already inserted in the trachea can be easily and safely performed under spontaneous breathing in a pediatric patient with TCS.
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Acta Anaesthesiol Taiwan · Sep 2006
Case ReportsEpidural analgesia masked the diagnosis of femoral neuropathy following renal transplantation.
Kidney transplantation related femoral neuropathy can mimic epidural catheter related radiculopathy in clinical presentation. Anesthesiologists should keep this possibility in mind when performing epidural anesthesia or analgesia for kidney transplantation. We present a 52-year-old male who after undergoing cadaveric kidney transplantation under general anesthesia in combination with epidural analgesia made possible by catheterization via T11-12 interspace for reinforcement of anesthesia and for postoperative patient-controlled epidural analgesia (PCEA) sustained sensory disturbance and muscle weakness of the lower limbs. ⋯ The final diagnosis turned out to be surgical procedure related femoral neuropathy. We believe this is the first instance ever reported about the dilemma in making a predicative diagnosis from two conditions near akin in kidney transplantation. Accurate diagnosis made through serial image and electrophysiologic studies are essential to appropriate management.
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Acta Anaesthesiol Taiwan · Sep 2006
Case ReportsCombined subdural and epidural block in a case of epidural catheterization for postoperative analgesia.
We report a case of unusual block caused by postoperative epidural analgesia for laparotomy in a gynecologic patient in consequence of inadvertent epidural catheterization. The clinical manifestation included agitation, spotty distribution of analgesia, wide spread of sensory block and loss of motor power. The radiological findings suggested a multicompartmental block with the anchorage of the catheter tip stretching over the epidural and subdural spaces. The default of catheter position was not detected during routine test dose procedure.