Masui. The Japanese journal of anesthesiology
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Spinal hematoma is a rare and serious complication anesthesia. Risk factors for spinal hematoma during neuraxial anesthesia are anatomic abnormalities, impaired hemostasis and difficult needle placement. ⋯ In order to reduce the risk of spinal hematoma in patients receiving heparin, it is recommended that the needle placement and catheter removal should be done when the anticoagulant effect of heparin is at the minimum. Postoperative evaluation of the neurological status is also important for early detection of a spinal hematoma.
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Knowledge and information were acquired from the results of the annual perioperative pulmonary thromboembolism (PPT) research from 2002 to 2004 by the Japanese Society of Anesthesiologists. Due to the popularization and use of prophylaxis, perioperative pulmonary thromboembolism (PPT) decreased significantly in 2004 compared to the years 2002 and 2003 (P < 0.001). The types of surgery with the highest incidence of PPT were hip/extremity surgery (7.48 per 10,000 cases), spinal surgery (6.30 per 10000 cases) and laparotomy (5.32 per 10,000 cases). ⋯ The proportion of obese men (20-40 yrs) with PPT was 2 fold higher, and in women (20-50 yrs) it was three fold higher, than that of the general population. In our investigation, the mortality rate of the PPT patient without prophylaxis was significantly higher than that of the patient with prophylaxis (P < 0.01). The predictive factors for death in our logistic regression were male gender, immobility, and lack of prophylactic treatment.
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Pentax AWS Airway Scope (Pentax, Japan) is a new videolaryngoscope. We successfully used the device in 15 patients and in other two patients with difficult airways. In a 51-year-old woman, after induction of anesthesia and neuromuscular blockade, laryngoscopy using a Macintosh blade showed only the tip of the epiglottis and tracheal intubation failed. ⋯ At laryngoscopy using a Macintosh blade, the epiglottis was long and tubular, and tracheal intubation failed. With the Airway Scope, the trachea was intubated easily. We believe that the Pentax AWS videolaryngoscope is useful in patients with and without difficult airways.
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We experienced a case of the abortive malignant hyperthermia (MH) that had developed during operation. The patient was a 14-year-old girl, and plastic surgery was scheduled under general anesthesia. Serum creatine kinase (CK) levels were high with 505 IU x l(-1) at the preoperative examination. ⋯ As sevoflurane, promotes the CICR (calcium-induced calcium release) mechanism, the trigger of this case is probably sevoflurane. As for the symptom that makes us doubt MH first, there is a maked rapid rises of Et(CO2). Therefore, it is important monitor and recognize the first symptom of MH.
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Mulvihill-Smith syndrome is a rare disease that belongs to progeroid syndromes. This syndrome is characterized by a senile face with an underdeveloped lower half, short stature, microcephaly, multiple pigmented nevi, immunodeficiency, hearing loss, and high-pitched voice. We report anesthetic management of a 27-year-old woman, 138 cm and 27 kg, with this syndrome, who underwent removal of mandibular cyst, partial resection of tongue and keratoplasty. ⋯ The changes of blood pressure during anesthesia were extraordinary, suggesting the presence of advanced arteriosclerosis. The postoperative course was uneventful, with stable hemodynamics, and the patient was discharged from the hospital on 9th postoperative day. Anesthesia for Mulvihill-Smith syndrome should be performed with caution for the potential risk of difficult airway and unstable hemodynamics.