Masui. The Japanese journal of anesthesiology
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Case Reports
[Epidural blood patch as a successful treatment of Barrè-Lièou syndrome: report of two cases].
Barrè-Lièou syndrome accompanies neurological symptoms after neck sprain, and is often difficult to treat. We describe two young men with various neurological symptoms after traffic accident, who were diagnosed with Barrè-Lièou syndrome. Both case 1 (41-year-old man) and case 2 (34-year-old man) showed no abnormal findings in head and cervical X-ray, CT-scan and MRI. ⋯ Severe complication, for example epidural infection or neurological disorders due to hematoma, was not noticed. While neural blockade did not relieve pain before EBP, we could get good effect from neural blockade for remaining symptoms after EBP. We consider that Barrè-Lièou syndrome is due to CSF leak and EBP may be one of the useful treatments.
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Pulmonary thromboembolism (PTE) is a crucial complication characterized by rapid onset and a high mortality rate. There are few reports concerning perioperative incidence of PTE and deep vein thrombosis (DVT) among Japanese population. All surgical patients excluding young patients for minor surgery were equipped with calf- or thigh-length intermittent pneumatic compression (IPC) device as a DVT preventive method during the period of immobility. ⋯ All patients with DVT or PTE were 66 years or older, and all patients were diagnosed by computer tomography, venography and pulmonary angiography between 7 to 14 days after each operation. One patient was surgically treated by embolectomy and removal of intraarterial thrombus, and others were treated with thrombolysis, anticoagulants and placement of vena cava filters. For prevention of DVT and PTE, other preventive methods such as anticoagulants and prolonged application of IPC should be necessary.
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Case Reports
[Anesthetic management of a patient with non-bullous congenital ichthyosiform erythroderma].
Non-bullous congenital ichthyosiform erythroderma is a disorder in the cornification of the skin, histopathologically characterized by hyperkeratosis. Previous reports mentioned that the fixation of endotracheal tubes and ECG electrodes to the skin was likely to be infirm in the patients with this disorder, and that the patients' body temperatures were easily affected by the environment. A 3-year-old girl with non-bullous congenital ichthyosiform erythroderma underwent two operations separately under general anesthesia. ⋯ The patient became severely hypothermic during the first operation. Fortunately, the intraoperative body temperature could be maintained at a normal level during the second operation with the use of a forced-air warming system. Careful perioperative consideration is required for the fixation of endotracheal tubes and the management of body temperature in patients with non-bullous congenital ichthyosiform erythroderma.
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Since we began to use a plate-rack as a pillow for adult endotracheal intubation, we can intubate more smoothly than we did with a circular sponge-made pillow previously. A pillow for endotracheal intubation must have two characteristics for smooth endotracheal intubation. First, it must be able to establish patient's head position suitable for endotracheal intubation. ⋯ This plate-rack can answer all of them. Particularly, we can do endotracheal intubation without neck extension, with patient's head on the upper horizontal bar of the plate-rack. Neck extension might cause worse visualization of the vocal cord and cervical spinal cord injury.
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We experienced a case of inadequate sedation because of inappropriate use of TCI system for fentanyl. ⋯ When the administration time is short, the anesthesiologist must be aware of the difficulty in distinguishing the human error of choosing one drug for the TCI system for another drug.