Masui. The Japanese journal of anesthesiology
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Coronary artery fistula is rare in congenital heart diseases but is the major disease among "coronary" congenital diseases. In a coronary artery fistula, the coronary artery tip connects directly or via an unusual blood vessel to unusual parts, such as the inside of the heart chamber, pulmonary artery or superior vena cava. Left ventricular volume overload and coronary steal phenomenon are serious symptoms. ⋯ We confirmed that only one shunt was located at the supra pulmonary valve area, and we consulted the diagnosis to surgeons. As a result, one shunt was found in the surgical view at the same position. Perioperative TTE and TEE are useful for surgical decision.
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The transversus abdominis plane (TAP) block is a newly described technique introducing a local anesthetic agent between the internal oblique and the transversus abdominis muscles of the abdominal wall, which is safer and more reliable analgesia in recent years by ultrasound technique. We report the perioperative management of transversus abdominis plane block with catheterization for a patient with severe cardiac dysfunction and chronic kidney failure, who underwent bilateral inguinal hernioplasty. ⋯ During the operation, the patient received a target-controlled infusion of 0.4-0.6 microg x ml(-1) propofol. The perioperative courses were uneventful and there was no adverse effect including central nervous system (CNS) symptoms.
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Comparative Study
[The effect of rocuronium and sugammadex in hepatic tumor patients without preoperative hepatic impairment].
The effect of rocuronium and sugammadex in patients undergoing hepatectomy due to hepatic tumor without preoperative hepatic impairment were investigated. ⋯ Rocuronium-induced neuromuscular block was prolonged in hepatectomy patients even without preoperative hepatic impairment but the reversal with sugammadex was effective.
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Intracranial subdural hematoma (SDH) occurred in a 58-year-old female after laparoscopy-assisted distal gastrectomy under general and thoracic epidural anesthesia. On postoperative day 2, she complained of headache in sitting position, but there were no remarkable neurological defect and nausea. On postoperative day 5, her headache subsided and she could walk by herself. ⋯ Her condition improved and was discharged on postoperative day 17 without subsequent complications. SDH after epidural anesthesia is rare, but diagnosis in early stage has a decisive influence on its prognosis. It is crucial to exclude the possibility of SDH and observe closely if the patient complains of severe headache or another unexplained symptom only with postdural puncture headache.
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Case Reports
[Successful internal jugular venipuncture in an infant with a high risk of puncturing the vertebral artery].
A five-month-old baby girl, 61.8 cm in height and weighing 4.9 kg, underwent ventricular septal defect repair under general anesthesia. Authors checked for small vessels around the IJV using an ultrasound echo apparatus with a 5/10-MHz probe (TiTAN, SonoSite Co., Tokyo, Japan) at a point 28 mm from the clavicle over the IJV. We observed a 3.8-mm-wide and 8.7-mm-deep vertebral artery 1.3 mm behind the 5.5-mm-wide IJV with color Doppler flow imaging for CVC. ⋯ The operator punctured the IJV carefully using real-time ultrasound guidance with a 24 G plastic puncture needle (Jelco Plus, Smith Medical, Tokyo, Japan), and avoided puncturing the vertebral artery. The CVC was successful, and no after-effect was observed following the operation. Before inserting the puncture needle each time, one should check for small arteries behind the IJV with color Doppler flow imaging.