Journal of anesthesia
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Journal of anesthesia · Jan 2009
Case ReportsThree-dimensional CT image analysis of a tracheal bronchus in a patient undergoing cardiac surgery with one-lung ventilation.
The incidence of a tracheal bronchus--that is, a congenitally abnormal bronchus originating from the trachea or main bronchi--is 0.1%-2%. Serious hypoxia and atelectasis can develop in such patients with intubation and one-lung ventilation. ⋯ A type I tracheal bronchus and segmental tracheal stenosis were identified on postoperative three-dimensional (3D) computed tomographic (CT) images. Preoperative examination of chest X-rays, CT images, and preoperative tracheal 3D images should preempt such complications and assist in securing safe and optimal one-lung ventilation.
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Journal of anesthesia · Jan 2009
Case ReportsTransient lower limb pain following accidental thoracic subarachnoid insertion of an epidural catheter.
Transient sensory disturbances, including dysesthesia or neurologic deficits in the lower extremities or buttocks have been described as complications of neuraxial anesthesia. We report a case of transient lower limb pain following the accidental placement of an epidural catheter into the thoracic subarachnoid space. A 31-year-old woman was scheduled to undergo laparoscopic myomectomy. ⋯ All signs of allodynia had disappeared on postoperative day 25. Sagittal and axial T2-weighted magnetic resonance imaging (MRI) at the Th12 level revealed a small high-intensity area without mass effect in the ipsilateral dorsal column. The patient's clinical course and MRI diagnosis suggested the inhibition of descending inhibitory pathways resulting from a lesion of the spinal cord as the possible etiology of the transient lower limb pain and allodynia.
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Journal of anesthesia · Jan 2009
Case ReportsBronchoscope-guided intubation through a Laryngeal Mask Airway Supreme in a patient with a difficult-to-manage airway.
We report a case of an obese patient who presented with laryngeal edema and difficult ventilation after failed attempts to intubate. A Laryngeal Mask Airway Supreme (LMA Supreme) reestablished the ventilation and allowed bronchoscope- guided intubation of the trachea. The case suggests that the LMA Supreme may be useful in patients with a difficult airway.
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Journal of anesthesia · Jan 2009
Case ReportsDexmedetomidine facilitates induction of noninvasive positive pressure ventilation for acute respiratory failure in patients with severe asthma.
Noninvasive positive pressure ventilation (NPPV) has been reported to be effective for acute respiratory failure in patients with severe asthma. Although NPPV requires less sedative than invasive mechanical ventilation, agitated patients with severe asthma should be given the minimum sedation necessary to facilitate the induction of NPPV. Two asthmatic patients (a 65-year-old man and a 32-year-old woman) separately presented to the intensive care unit with exacerbating respiratory failure. ⋯ While the Ramsay sedation scale was maintained at 2 or 3 during the continuous dexmedetomidine infusion, we successfully weaned the patients from NPPV by reducing the inspiratory PAP. Dexmedetomidine helped the agitated patients cooperate with mask ventilation without inducing respiratory depression. We conclude that dexmedetomidine may be a valuable sedative to facilitate the induction of NPPV.
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Journal of anesthesia · Jan 2009
Case ReportsUse of Intralipid in an infant with impending cardiovascular collapse due to local anesthetic toxicity.
Local anesthetic-associated cardiac toxicity following caudal epidural blockade is, fortunately, a rare event. Prompt recognition and early treatment is the key to successful resuscitation. Early use of the lipid emulsion Intralipid in bupivacaine-induced cardiac toxicity may lead to a good outcome.