Masui. The Japanese journal of anesthesiology
-
We report a case where "laryngospasm notch" technique was used in a patient to initiate spontaneous respiration during general anesthesia. The patient was a 43-year-old woman who underwent conization. A Pro-Seal laryngeal mask airway was inserted after induction of general anesthesia. ⋯ Surgical course was uneventful until the patient became unable to breathe towards the end of surgery. Positive-pressure ventilation was applied, but the patient could not be ventilated. "Laryngospasm notch" technique was performed by applying digital pressure in front of the tragus of the ears, and the patient began to breathe spontaneously. We describe our experience with the "laryngospasm notch" technique applied to the front of the tragus of the ears to treat laryngospasm.
-
The Japanese Society of Anesthesiologists (JSA) has investigated the incidence of postoperative pulmonary thromboembolism (PTE) for several years. ⋯ Our data suggest that the actual incidence of postoperative PTE in Japan may be far greater than that reported by the JSA.
-
We experienced an incident of the stricture caused by the degradation of an O-ring in the oxygen outlet of the central piping. The event was identified by the intermittent decrease of the central piping oxygen supply pressure into the anesthesia machine. ⋯ The cyclical rhythm of the declining oxygen supply pressure means that oxygen supplies decreases with the increase of oxygen consumption, and it may be a sign of serious malfunction. Therefore, it is necessary to check the pressure deviations under use of high-flow oxygen.
-
We report an obese patient who developed rhabdomyolysis after prolonged surgery in lateral decubitus position. A 55-year-old woman, with a body mass index of 29.3 kg x m(-2), underwent removal of an acoustic neurinoma in lateral decubitus position which lasted 20 hours. ⋯ There were elevated levels of serum creatinine phosphokinase, AST, ALT, and myoglobin in the urine. CT of the abdomen taken two days after the surgery suggested the presence of rhabdomyolysis of the transverse abdominal muscles.
-
Agitation during the emergence from general anesthesia is a great post-operative problem that often injures the patients themselves and requires the medical staff to restrain and calm the patients. The predisposing factors for emergence agitation include anesthesia, operation, and patient. Sevoflurane anesthesia results in higher incidence of emergence agitation than halothane, because of the rapid emergence, and its effects on central nervous system inducing convulsion and post-operative behavioral changes. ⋯ The change from sevoflurane to propofol during anesthesia maintenance is a contributing factor to reduce incidence of emergence agitation. The medications including opioids, midazolam, alpha-2 agonists, ketamine, non-steroidal anti-inflammatory drugs, nitrous oxide, and propofol, and aggressive nerve block such as caudal epidural block for post-operative sedation and analgesia are effective to avoid incidence of emergence agitation. The calm emergence following general anesthesia would decrease the self-injuring behavior, and enhance the parent and caregiver satisfaction in general anesthesia and surgery.