Masui. The Japanese journal of anesthesiology
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Helmet is a new device of non-invasive continuous positive airway pressure (CPAP). Few cases have been described about usage of the helmet in children. We describe successful treatment of a child with respiratory distress using the helmet-delivered non-invasive CPAP. ⋯ Helmet CPAP started at initial settings of CPAP 8 cm H2O and FI(O2) 0.7, improved oxygenation. Pa(O2)/FI(O2) ratio increased from 106 to 316, and chest X-rays showed a marked improvement (15 hour after NPPV initiation). The helmet offers important advantage: the possibility of fitting to any children, regardless of any facial or external anomalies.
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A 60-year-old morbidly obese woman (150 cm, 112 kg, BMI 49.8) underwent total knee replacement under general anesthesia combined with sciatic nerve block and continuous femoral nerve block. Following induction of general anesthesia and tracheal intubation, the sciatic nerve was blocked using the popliteal approach with the patient in the supine position. Then the femoral nerve block was performed, followed by perineural catheter placement for postoperative continuous local anesthetic infusion. ⋯ Postoperatively 0.15% ropivacaine was infused at the rate of 5 ml x hr(-1) for 60 hours through the femoral catheter, which provided satisfactory pain relief in combination with scheduled loxoprofen administration. No block-related complications were noted. Our experience suggests that the ultrasound-guided technique may prove useful to facilitate safe and accurate block when technical difficulties are anticipated with anatomic landmark-based approaches.
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Case Reports
[Anesthetic management of a low birth weight infant with giant sacrococcygeal teratoma].
We report the anesthetic management of a low birth weight infant (1912 g including the tumor) with a giant sacrococcygeal teratoma (Altman type II). The diagnosis was prenatally made at 24 weeks of gestation. She was delivered by emergent cesarean section at 28 weeks gestation, because fetal heart failure was aggravated by arteriovenous shunting through the tumor. ⋯ The resected tumor weighed 766 g, total blood loss was 770 ml and blood transfusion was 965 ml. Although transient acidosis and hyperkalemia occurred, the surgery was completed and she was transferred to a neonatal intensive care unit in stable condition. In this case, nasotracheal intubation and the insertion of a central venous line were necessary and useful for the anesthetic management of the resection of giant sacrococcygeal teratoma.
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Epidural anesthesia is widely used in patients who undergo thoracic, abdominal or lower extremity surgeries and generally considered useful for perioperative analgesic management. Epidural catheterization is often associated with some complications including misplacement of the catheter. Epidural catheters are known to be misplaced or migrate into subarachnoidal space, subdural space, vessels and thoracic cavities ; however, frequency, predominant sites of misplacement, and the timing of detection are not fully understood regarding the misplacement of the catheters. ⋯ Epidural catheters were misplaced to subarachnoid space in 6 cases and thoracic cavity in 2 cases. The misplacement of the catheters was found before the induction of general anesthesia in 2 patients, after induction of general anesthesia in 1 patient, during surgical procedure in 3 patients, and postoperatively in 2 patients. Since misplacement of epidural catheters can occur at any moment during perioperative period, continuous monitoring and observation of patients seem to be very important to prevent and minimize the adverse events related to the misplacement of epidural catheters.
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A radical hysterectomy was performed in a patient complicated with bronchiectasis, under combined spinal-epidural anesthesia. The patient was asymptomatic and preoperatively diagnosed with bronchiectasis on an anesthetic consultation with an anesthesiologist. ⋯ It was necessary to administer a supplemental epidural dose of 0.375% ropivacaine fifty minutes after the start of the operation. Postoperative epidural analgesia was effective and no perioperative complications were observed.