Journal of anesthesia
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Journal of anesthesia · Apr 2012
Case ReportsA case of acquired hemophilia A with massive hemothorax.
Acquired hemophilia A (AHA) is an uncommon but potentially life-threatening hemorrhagic disorder caused by the development of an inhibitor against coagulation factor VIII (FVIII). AHA is very rare, affecting approximately 1 in 1 million individuals. However, the incidence may actually be higher, because diagnosis is difficult and the disease can be overlooked. ⋯ The patient was diagnosed with presumed AHA based on acute onset of bleeding symptoms and unexplained isolated prolonged activated partial thromboplastin time. Diagnosis was definitely established by demonstrating a decrease in FVIII activity, presence of FVIII inhibitor activity, and normal von Willebrand factor. The patient was successfully treated with recombinant activated coagulation factor VII and transcatheter artery embolization of the intercostal arteries.
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We encountered three cases of lung disorders caused by drowning in the recent large tsunami that struck following the Great East Japan Earthquake. All three were females, and two of them were old elderly. All segments of both lungs were involved in all the three patients, necessitating ICU admission and endotracheal intubation and mechanical ventilation. ⋯ In at least two cases, misswallowing of oil was suspected from the features noted at the time of the detection. Sputum culture for bacteria yielded isolation of Stenotrophomonas maltophilia, Legionella pneumophila, Burkholderia cepacia, and Pseudomonas aeruginosa. The cause of tsunami lung may be a combination of chemical induced pneumonia and bacterial pneumonia.
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Journal of anesthesia · Apr 2012
The impact of hyperlactatemia on postoperative outcome after adult cardiac surgery.
To evaluate the value of blood lactate value in predicting postoperative mortality (primary outcome), duration of ventilation, and length of stay in an intensive care unit (ICU) and hospital (secondary outcomes). ⋯ Hyperlactatemia is common after cardiac surgery. Maximal lactate threshold ≥4.4 mmol/l in the first 10 h after operation accurately predicts postoperative mortality.
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Journal of anesthesia · Apr 2012
Case ReportsAnesthesia in an adult patient with tracheal hemangiomas: one-lung ventilation for lung lobectomy.
Primary tracheal tumors are rare in adults, and careful airway management is required during anesthesia for affected patients. We report the case of a patient with tracheal hemangiomas undergoing nontracheal operation. A 61-year-old woman was scheduled for a lung operation. ⋯ The operation was performed uneventfully, and the tracheal tube was replaced postoperatively with a laryngeal mask airway while the patient was under deep anesthesia and neuromuscular blockade. The mask was removed after confirming lack of bleeding from the hemangiomas. No hypoxia or other complications occurred during or after the operation.
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Journal of anesthesia · Apr 2012
Case ReportsPercutaneous electrode placement for spinal cord stimulation in a patient with spinal fusion: a technical report.
A spinal cord stimulation (SCS) trial was attempted to alleviate left knee pain in a patient with spinal fusion from T12 to L4. Good paresthesia coverage for the knee pain was attained with SCS. However, while removing the needle used for electrode placement, the needle became fixed in the bony supplementary tissue. ⋯ Without the hub, we had no choice but to use a pneumatic drill for removing the needle. Accordingly, the supplementary bone tissue was drilled under real-time imaging, using a pneumatic drill with a 3.2-mm drill bit, and another epidural needle was inserted through the hole. We consider that, in patients with spinal fusion, making a borehole with a pneumatic drill for introducing the epidural needle for percutaneous SCS electrode placement may be advisable in order to avoid the above-mentioned difficulties.