Masui. The Japanese journal of anesthesiology
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We recently encountered three cases of the leakage from the connecting portion of sevoflurane vaporizer in Fabius Tiro produced by Drager company, and in one case of those, oxygen saturation decreased. The connecting portion had leakage merely in the contact with the fixture of the monitor, because of the structure easily displaced by an external force. Further, it was difficult to detect the leakage due to the ability to correct the insufficient supply of fresh gas by taking in air. We hope a reform of the connecting portion and an alarm to inform it if the anesthesia machine detects the leakage.
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Painful diabetic neuropathy is a common, difficult-to-manage complication of diabetes. We report two case of intractable painful diabetic neuropathy which occurred after the rapid lowering of blood sugar level. Although pregabalin, antidepressants, opioid analgetics and various nerve block did not improve their pain, clomipramine dramatically reduced their pain.
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Case Reports
[Use of Airwayscope with pediatric intlock in a patient with first and second branchial arch syndrome].
First and second branchial arch syndrome is a congenital anomaly of craniofacial dysplasia involving organs derived from the second branchial arch. The main characteristics are microtia and mandibular hypoplasia. A 6-year-old boy was scheduled for adenoidectomy and bilateral myringotomy and tube placement. ⋯ Control of the bronchoscope consequently became easy We successfully guided it to his glottis and performed tracheal intubation. His condition was stable during the procedure. In conclusion, we safely performed tracheal intubation in a patient with first and second branchial arch syndrome using the AWS and a fiberoptic bronchoscope.
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Case Reports
[Case of pharyngeal laceration associated with the use of airwayscope in a patient with difficult airway].
A 54-year-old woman with atlantoaxial subluxation in rheumatoid arthritis was scheduled for total elbow arthroplasty. Since her neck was stabilized with a cervical collar and her interincisor distance was 1.5 finger-breadth, a difficult airway was anticipated. Anesthesia was induced with propofol and fentanyl. ⋯ Following aspiration of blood, the trachea was intubated using a flexible fiberoptic bronchoscope under AWS guidance. After the operation, a view of bronchoscopy by an otolaryngologist revealed three lacerations from the mucosa to muscle layer in the pharynx. The lacerations could have resulted from use of AWS in a patient with a small mouth opening and with vulnerable mucosa due to long-term steroid therapy.
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Ultrasound-guided peripheral nerve blocks in the abdominal wall, such as transversus abdominis plane block (TAP block) and rectus sheath block, are now widely used. We report a case of Leriche's syndrome treated with safe and effective analgesia after laparotomy by abdominal wall block and continuous infusion. A 61-year-old man diagnosed with Leriche's syndrome underwent Y-graft replacement for an abdominal aortic aneurysm. ⋯ When the wound was closed, a catheter was passed through an 18-gauge Tuohy needle placed above the fascia along the supraumbilical site. After the operation, 0.2% ropivacaine was continuously delivered at a rate of 6 ml hr-1 through the catheter. We could provide the patient with effective analgesia after surgery.