Masui. The Japanese journal of anesthesiology
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Case Reports
[A case report of hemidiaphragmatic paresis caused by interscalene brachial plexus block].
A 76-yr-old woman was scheduled for left upper extremity orthopedic procedure. Preoperative examinations were within normal limits except forced vital capacity. Interscalene brachial plexus block with 0.25% bupivacaine 15 ml, was performed under general anesthesia. ⋯ A chest X-ray demonstrated the elevation of hemidiaphragm. She was diagnosed as ipsilateral hemidiaphragmatic paresis, treated with oxygen inhalation under deep breathing for approximately one hour, and then transferred to the common ward. We conclude that respiratory movement should be carefully observed following interscalene brachial plexus block especially in geriatric patients.
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A 49-year-old female with mitochondrial encephalomyopathy underwent surgery for implantation of an artificial cochlear device. She had some characteristic clinical features, including muscle weakness, deafness and dementia. Anesthesia was induced with 5 mg.kg-1 of propofol, and the trachea was intubated without a muscle relaxant. ⋯ Bispectral index (BIS) was monitored and maintained at approximately 40. No cardiovascular instabilities or increase in plasma lactate concentration were observed during surgery. The patient had a smooth recovery from the propofol anesthesia, and the BIS value returned to the pre-anesthetic level 10 min after completion of the anesthesia, suggesting that the use of propofol is a safe means for inducing and maintaining anesthesia in patients with mitochondrial encephalomyopathy.
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To determine low hemoglobin concentrations in the washed fluid is useful for calculation of blood loss and that in the supernatant is also useful for evaluation of hemolysis during extracorporeal circulation or in the blood preparations. The HemoCue Low Hemoglobin Photometer is a new lightweight device, which is easily movable anywhere and is able to determine hemoglobin concentration in low ranges (0.03-3.00 g.dl-1). We investigated the accuracy and reliability of the HemoCue Low Hemoglobin Photometer. ⋯ A high positive correlation was found between the values measured by the HemoCue Low Hemoglobin Photometer (Y) and the calculated values (X); Y = 1.047 X, r = 0.999, P < 0.0001. It took only 11-54 seconds (mean value: 31.4 seconds) for the measurement. It is concluded that the HemoCue Low Hemoglobin Photometer is a reliable and useful device for measurement of low hemoglobin concentration.
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Case Reports
[Fiberoptic tracheal intubation aided by jaw lifting in a patient with an epiglottic cyst].
Epiglottic cyst is known to cause difficult intubation. We report a patient with an epiglottic cyst whose trachea was successfully intubated with the aid of fiberoptic bronchoscopy combined with the jaw lift maneuver. A 29-year-old patient was scheduled for lumbar disk hernia surgery. ⋯ Next, we applied the jaw lift maneuver in conjunction with bronchoscopy. The maneuver improved the glottic view by clearing the epiglottis from the posterior pharyngeal wall and the patient's trachea was successfully intubated. Jaw lifting could be a useful adjunct to fiberoptic bronchoscopy for tracheal intubation in patients with epiglottic cysts.
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Randomized Controlled Trial Clinical Trial
[Efficacy of bispectral index monitoring in improving anesthetic management, economics, and use of the operating theater].
This study was designed to assess the efficacy of bispectral index (BIS) monitoring in reducing the amount of volatile anesthetics used and improving recovery profiles. Sixty patients (ASA physical status 1 or 2) undergoing various surgical procedures under sevoflurane/nitrous oxide anesthesia were studied. The patients were randomly assigned to two groups of which anesthesia was carried out with (BIS group) or without (control group) monitoring BIS, and in the latter, anesthesiologist was blinded to the BIS values. ⋯ Compared with control group, the patients in BIS group were extubated earlier and became eligible for discharge earlier from recovery room than control group. There was no significant difference in the incidence of intraoperative complications between the groups. Titrating sevoflurane concentration with BIS monitoring during anesthesia decreased anesthetic consumption and improved recovery compared with standard clinical practice.