Masui. The Japanese journal of anesthesiology
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Case Reports
[Use of intubating laryngeal mask airway for three patients with difficult intubation].
We used intubating laryngeal mask airway (ILM) for three patients with difficult intubation, and tracheal intubation was successfully performed through the ILM in all three cases. Difficult intubation in the first case was caused by direct invasion of malignant lymphoma into the right maxillary sinus leading to restricted mouth opening. ⋯ Subsequently, all patients were intubated through the ILM successfully. We realized that the ILM is useful and should be prepared on the induction of anesthesia in patients suspected of difficult intubation.
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Comparative Study
[Continuous monitoring of hemoglobin oxygen saturation of the hepatic vein in patients undergoing laparoscopic cholecystectomy].
We monitored of hemoglobin oxygen saturation of the hepatic vein (ShvO2) continuously in 6 patients undergoing laparoscopic cholecystectomy under inhalation anesthesia only, and in 6 patients under combined epidural and inhalation anesthesia. In inhalation anesthesia only group, arterial blood pressure increased and ShvO2 values decreased immediately after intraperitoneal insufflation with CO2, demonstrating the mean lowest ShvO2 value of 25 percent. In combined anesthesia group, arterial blood pressure and ShvO2 values were unchanged after the intraperitoneal insufflation compared with values obtained before the insufflation. The results indicate that hepatic blood flow may be better preserved with combined epidural and inhalation anesthesia than with inhalation anesthesia only, suggesting that sympathetic block by epidural anesthesia may contribute to this favorable effect on ShvO2.
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Case Reports
[Two cases of extreme hemodilution caused by massive hemorrhage immediately after start of operation].
We describe two cases of extreme hemodilution due to large amounts of fluid infusion for unexpected massive hemorrhage. In both cases, unexpected hemorrhage with difficult hemostasis occurred within 60 min after the start of the operation. For lack of transfused blood, large amounts of fluid infusion using crystalloid and colloid solutions including 5% albumin, plasma expander and lactated Ringer's solution were administered to maintain circulatory blood volume. ⋯ In one case, intraoperative autotransfusion with Cell-Saver was performed. In spite of intraoperative extreme hemodilution, their postoperative courses were uneventful. Intraoperative awareness was present in both cases.
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We experienced arytenoid dislocation in a 17-year-old man with no significant medical history, who underwent anterior cruciate ligament reconstruction under general anesthesia. After induction of anesthesia, the trachea was easily intubated with an 8.0 mm cuffed endotracheal tube. The operation lasted approximately four hours. ⋯ Four weeks had passed before the diagnosis of right arytenoid cartilage dislocation was made by fiberoptic laryngoscopy. Voice therapy was started. Three weeks after starting voice therapy, the patient's voice was restored almost to the preoperative status.
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The amide-linked local anesthetics can be used safely in patients susceptible to malignant hyperthermia (MH). 4-Hydroxybenzoic acid methyl ester contained as a preservative in local anesthetic solution was suspected to have triggered MH in a patient who had received nerve block with lidocaine solution. The author investigated the effects of 4-hydroxybenzoic acid methyl ester on Ca(2+)-related functions of the skeletal muscle using saponin-treated skinned fibers from the extensor digitorum longus muscle of guinea pigs. 4-Hydroxybenzoic acid methyl ester accelerated the Ca2+ induced Ca2+ release (CICR) rate from the sarcoplasmic reticulum (SR) in a dose-dependent manner, and the Ca2+ concentration-CICR rate curves were shifted to the left with 4-hydroxybenzoic acid methyl ester at concentrations above 30 microM. 30 microM of 4-hydroxybenzoic acid methyl ester is associated with a plasma concentration of lidocaine intoxication which induces general convulsion. Ca2+ uptake, initial rate of Ca2+ uptake by the SR and Ca2+ sensitivity of the contractile system were not affected by 100 microM of 4-hydroxybenzoic acid methyl ester. These results suggest that amide-type local anesthetic solutions and agents containing 4-hydroxybenzoic acid methyl ester as a preservative may trigger MH in MH susceptible patients, if they are accidentally administered into the blood vessel.