Masui. The Japanese journal of anesthesiology
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Case Reports
[Interscalene block combined with general anesthesia under spontaneous breathing in a patient with a giant bulla].
Respiratory management for patients with a giant bulla during anesthesia should avoid positive-pressure ventilation to reduce the risk of barotraumas. We report a case of anesthetic management of a 42-year-old man with a giant bulla who had an elective surgery for biopsy of a tumor on his left elbow. Balanced anesthesia consisting of general anesthesia was given under spontaneous breathing combined with interscalene brachial plexus blockade for intra- and postoperative analgesia for the elbow surgery. ⋯ The airway was maintained with a size 4 LMA-Proseal, which was inserted with care under spontaneous breathing. There were no serious complications such as pneumothorax in perioperative period. We performed successful anesthetic management, without any complications, combined with interscalene brachial plexus block and spontaneous breathing in a patient with a giant bulla.
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A 58-year-old man with hypertension underwent laparoscopic distal gastrectomy under general and epidural anesthesia. Preoperative laboratory date revealed a normal platelet count and normal coagulation profile. Epidural puncture was successfully performed at the T9-10 intervertebral space on the first attempt without bleeding. ⋯ Ten minutes later, paraplegia disappeared spontaneously. It is suggested that the spinal cord of the patient was subjected to transient pressure hematoma. A decline in blood pressure may have caused the blood to spread through the epidural space, such that the neurologic symptoms disappeared.