Masui. The Japanese journal of anesthesiology
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A case of 30 year-old female with HELLP syndrome, who had undergone emergency caesarean section under general anesthesia, was reported. HELLP syndrome is characterized by hemolysis, liver dysfunction and thrombocytopenia, besides symptoms of severe toxemia of pregnancy. ⋯ Though the eclampsia was recognized several times during and after the operation, the patient and her baby had no complication nor sequela on their discharge. The key in the anesthetic management of caesarean section in a patient with HELLP syndrome is to control hypertension and eclampsia, to consider the presence of liver and kidney dysfunctions, and to improve anemia and bleeding tendency.
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The laryngeal mask is a unique alternative to the face mask and endotracheal tube offering significant benefits to both anesthesiologist and patient. We have applied laryngeal mask, 1) to create an adequate airway in cases of difficult or impossible intubation, 2) to establish a pathway for the fiberoptic bronchoscope, 3) to clear the airway for eye operation, and 4) to maintain the airway in patients in the lateral position. Further study, however, is necessary to establish definite indication for its application.
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The supraclavicular brachial plexus block originated by Kulenkampff is useful but accompanies the danger of injury to the lung, i.e. pneumothorax, because the needle is directed caudad. Reviewing the anatomy of the brachial plexus in cadavers, we have found that the parascalene brachial plexus block originated by Vongvises is safer than Kulenkampff's method. We modified this block as follows: (1) An assistant pulls lightly the affected upper extremity caudad. (2) A 23-gauge 35 mm needle is inserted at right angles to the clavicle and directed cephalad at an angle of 0-30 degrees. ⋯ Our success rate was 92%. The only complication we encountered was Horner's syndrome which occurred in 20% of our cases. None of our patients showed clinical symptoms of pneumothorax, hematoma, epidural as well as subarachnoideal block, recurrent nerve paralysis or phrenic nerve paralysis.