Masui. The Japanese journal of anesthesiology
-
The incidence of a tracheal bronchus supplying the right upper lobe has been reported to be in the range of 0.1 to 3%. We encountered 3 cases with the anomaly among 200 cases of lung surgery conducted over a year at our hospital. ⋯ Patients with a tracheal bronchus may be difficult or impossible to ventilate, especially when requiring unilateral lung ventilation. Therefore, the airway must be assessed carefully by fiberoptic bronchoscopy prior to unilateral lung surgery, keeping in mind the possibility of a tracheal bronchus, in order to design a safe way to secure it safely during the surgery.
-
We studied the prevalence of postoperative complications and the predictor for the occurrence of postoperative delirium in patients who had received surgery for femoral neck fracture. ⋯ Our results indicate that it might be possible to prevent postoperative complications by careful perioperative management. Hearing loss preoperatively was a risk factor of postoperative delirium in advanced elderly patients.
-
Case Reports
[Case of laparoscopic cholecystectomy in a patient with glucose-6-dehydrogenase deficiency].
We report management of anesthesia in a patient suffering from glucose-6-phosphate dehydrogenase (G6PD) deficiency, a condition that induces acute hemolysis when associated with surgical stress and infection, or following the application of oxidant drugs. A 5 year-old-male patient, suffering from G6PD deficiency was scheduled for laparoscopic cholecystectomy. The patient had exhibited signs of hemolysis during the course of various infections and after ingesting fava beans (favism). ⋯ There was no hemolytic change during the perioperative period. It was clear that this combination of drugs provided safe anesthesia for the G6PD patient in the present study. The most important considerations for patients with G6PD deficiency is firstly, the avoidance of oxidative stress, which can be caused by a variety of different conditions, and secondly, the use of anti-oxidative anesthetic drugs.
-
Case Reports
[Combined spinal-epidural anesthesia for cesarean section in a patient with dilated cardiomyopathy].
We report successful anesthetic management of elective cesarean section in a 31-year-old patient with dilated cardiomyopathy (DCM) using combined spinal-epidural anesthesia (CSEA). After inserting an arterial catheter and central venous catheter, isobaric bupivacaine (0.5% ; 5 mg) with fentanyl 10 microg was injected intrathecally at the L4-5 interspace under administration of dopamine 3 microg kg(-1) min(-1). 10 min and later, a total of ropivacaine (0.5%; 70 mg) with fentanyl 50 microg was titrated at 2-3 min intervals through the epidural catheter inserted at the L1-2 interspace resulting in analgesic level of T4 25 min after induction of spinal anesthesia. A baby was delivered uneventfully with good Apgar score, and the patient's perioperative hemodynamic change was minimal. CSEA is a reliable, titratable technique, which provides excellent analgesia with minimal hemodynamic changes for patients with DCM undergoing cesarean section.