Masui. The Japanese journal of anesthesiology
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Case Reports
[A case of unanticipated postoperative respiratory distress from cancerous pleural effusion].
A 63-year-old woman with a 2-month history of abdominal distension received diagnostic laparotomy under general anesthesia. The chest X-ray one week preoperatively demonstrated slight left pleural effusion, but she did not show any dyspnea on preanesthetic interview. General anesthesia was induced with propofol, ketamine and fentanyl. ⋯ We consider that we diagnosed her state only from her subjective symptoms without considering objective symptoms. Besides we had to explain a possibility of a unanticipated serious respiratory distress. In such a case, more accurate and objective diagnostic procedures are required.
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Case Reports
[A case of pneumothorax during laparoscopic surgery due to latent diaphragmatic defect].
A 38-year-old male healthy donor for renal transplantation was scheduled to undergo laparoscopic nephrectomy of the left kidney. After commencement of the surgery under general anesthesia, his vital signs were stable. When pneumoperitoneum was commenced using CO2, a rapid increase in the airway pressure was observed, and it became difficult to perform mechanical ventilation. ⋯ Postoperative chest X-ray showed no signs of atelectasis, mediastinal emphysema, or aerodermectasia, suggesting the development of pneumothorax due to pure CO2. In this case, the defective pore in the diaphragm was caused accidentally by pneumoperitoneum, although the subject had had no prior symptoms. Latent diaphragmatic defect may be an important factor in pneumoperitoneum and other surgical procedures.
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Case Reports
[Intravenous thrombus detected during central venous catheterization under ultrasonic guidance].
A bedridden 88-year-old woman with cerebral infarction was scheduled for central venous catheterization through the right internal jugular vein under ultrasonic guidance. She had received central venous catheterization through the right internal jugular vein one month before, but the catheter had been removed nine days previously because of catheter infection. The right internal jugular vein was punctured under ultrasonic guidance, but blood regurgitation was not observed. ⋯ Risk factors for intravenous thrombus include advanced age, cerebral infarction, bedridden patient, and catheter-related infection. When attempting recatheterization through the same vein for patients with these risk factors, especially catheter-related infection, attention should be paid to the possibility of intravenous thrombus. In cases in which intravenous thrombus is suspected, catheterization should be attempted through another vein.
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A 59-year-old man with cervical spondylosis was scheduled for a posterior spine surgery. After induction of anaesthesia with propofol and fentanyl, and neuromuscular blockade with vecuronium, the trachea was intubated using an 8.0-mm ID refinforced tube, without difficulty. After inflation of the cuff with 6 ml of air, there was no gas leak around the tube. ⋯ A size 5 laryngeal mask airway was inserted while the tracheal tube was left in place with the patient in the prone position. Inflation of the cuff of the laryngeal mask with 15 ml of air and occluding the connector part of the laryngeal mask prevented the gas leak, and adequate ventilation volume could be maintained afterwards. We believe that insertion of the laryngeal mask airway may be useful in minimizing gas leakage around a tracheal tube.
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Randomized Controlled Trial
[Treatment of epidural morphine induced pruritus with butorphanol].
Epidural morphine has been used to provide postoperative analgesia. However, one of the most common side effects of epidural morphine is pruritus. The incidence may or may not be related to the dose of morphine administered. First, we examined whether epidural morphine induced a dose-related increase in pruritus or not. Secondly, the purpose of this study was to evaluate the relief of pruritus when a combination of epidural morphine (a mu-receptor agonist) and butorphanol (a mu-receptor antagonist and kappa-receptor agonist) was administered. ⋯ Butorphanol 2 mg x day(-1) was effective in preventing pruritus associated with continuous epidural infusion of morphine 3.3 mg x day(-1).