Masui. The Japanese journal of anesthesiology
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We report anesthetic management of a patient with laryngotracheoesophageal cleft which lacks partition between the esophagus and upper airway, a rare congenital anomaly with a high mortality. A male baby weighting 2.96 kg was born at 39-week gestation. He had respiratory distress, hoarse cry and cyanosis on feeding. ⋯ Endoscopic examination performed transnasally and through the endotracheal tube demonstrated that the septum between the trachea and esophagus was absent from the larynx through the entire length of the trachea. On the basis of these finding, this case was diagnosed as laryngotracheoesophageal cleft (type 3). Esophageal division and gastrostomy were performed to prevent regurgitation and aspiration of gastric content.
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We report a case of 31-year-old woman with pregnant toxicosis, who developed transient blindness after caesarean section under lumbar anesthesia. The patient was hypoxic due to atelectasis when she developed blindness, but she had no ophthalmologic abnormalities. MRI depicted abnormal high intensity areas (HIA) with T 2-weighted images (T 2 WI) in the occipital lobes and the basal ganglia. ⋯ The patient was diagnosed as cortical blindness due to RIND. Although most of the transient cortical blindness are accompanied with pregnant toxicosis with hypertension, there are some cases without pregnant toxicosis. We stress the importance of maintaining the blood pressure within the normal range in patients with hypertension who undergo surgery under spinal anesthesia.
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Case Reports
[Airway difficulty associated with multiple teratisms of the oral cavity in a newborn infant].
A 13-day-old infant with multiple teratisms of the oral cavity was scheduled for resection of the epignathus. Her oral cavity was occupied by large epignathus, submandibular tumor, congenital bifid tongue and cleft palate, but she had no other congenital abnormalities. We anticipated that an endotracheal intubation would be difficult because of the large size of the tumor in relation to the oral cavity. ⋯ Although a large elastic epignathus did not interrupt the insertion of the curved laryngoscope blade, the hard submandibular tumors protruded from the submaxillary ramport interfered with mid-line management of the laryngoscope. After several attempts of intubation, a better exposure was obtained and she was successfully intubated using a stylet under deep sedation. We recognized that a careful observation of anatomical abnormalities in the oral cavity is important to keep airway in an infant with multiple abnormalities of the oral cavity.
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Acceleration of heart rate simultaneously with excitatory movements was observed during anesthesia with propofol in four patients. Anesthesia was induced with propofol 2.5 mg.kg-1 i.v. and maintained with propofol 10 mg.kg-1.hr-1 i.v. About ten minutes after the induction, the patients showed jerking movements such as pronation or flexion of their arms, and/or plantar flexion. ⋯ Another patient with no involuntary movements showed no heart rate changes. These results suggest that heart rate acceleration in four patients was closely related to excitatory movements caused by propofol. As it was not influenced by muscular relaxation, heart rate monitoring would be useful to detect latent excitatory movements under muscular relaxation.
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We have retrospectively analyzed twelve pregnancies in nine patients with intracranial arteriovenous malformation (AVM) managed at our hospital from 1984 to 1995. Following radical excision of AVM before or during pregnancy in 6 cases, transvaginal deliveries were performed without untoward sequelae. ⋯ Anesthesia courses in two patients for the resection of ruptured AVM during pregnancy were uneventful under enflurane and nitrous oxide anesthesia, or balanced anesthesia using fentanyl and nitrous oxide in oxygen. Simultaneous cesarean section craniotomy was not performed at our hospital.