Masui. The Japanese journal of anesthesiology
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We report the successful rescue ventilation of a patient with severe obstructive sleep apnea syndrome after induction of general anesthesia using the i-gel supraglottic airway device. A 55-year-old man was scheduled for resection of a cerebellopontine angle tumor. He suffered from severe obstructive sleep apnea syndrome and routinely used continuous positive airway pressure. ⋯ We immediately inserted the i-gel device to provide sufficient ventilation. As tracheal intubation with the i-gel device was difficult, we intubated a spiral tube (internal diameter, 8.0 mm) using the Pentax-AWS Airwayscope. Our findings suggest that the i-gel device may be useful for emergent airway rescue in the event of impossible ventilation for patients with severe obstructive sleep apnea syndrome.
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Paraplegia is a serious complication after thoracoabdominal aortic aneurysm repair. Therefore, maintenance of spinal cord perfusion pressure, drainage of cerebrospinal fluid, and avoidance of opioids are important for prevention of paraplegia Management of acute post-thoracotomy pain is necessary not only to keep the patient comfortable but also to minimize postoperative complications. However, epidural analgesia, a common method of pain control, is hard to use because of existing postoperative coagulopathy and avoidance of spinal cord ischemia Although both paravertebral block and epidural analgesia provide comparable pain relief after thoracic surgery, paravertebral block has lesser detrimental effects on spinal cord perfusion and better preserves the possibility to monitor neurologic function than epidural analgesia. We report 7 cases in which paravertebral blockade was used for analgesia in patients who underwent thoracoabdominal aneurysm repair.
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Case Reports
[Anesthetic management of a patient with osteogenesis imperfecta combined with mandibular defect].
Osteogenesis imperfecta (OI) is a rare hereditary disorder characterized by an excessive tendency to bone fractures and retarded growth. We report an anesthetic management of the patient with OI who has the history of vertebral bone fracture by coughing. A 44-year-old female underwent mandibular resection and reconstruction with a metal instrument due to ossifying fibroma 35 years ago. ⋯ Considering incomplete respiration after extubation, the tracheal tube was extubated after inserting the tube exchanger into the trachea through the tube. The tube exchanger was pulled out after confirming spontaneous respiration and upper airway patency. The patient was cooperative, and respiratory and hemodynamic conditions were stable throughout.
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Patients with Klippel-Feil syndrome (KFS) frequently encounter difficult airway management due to skeletal abnormalities, including fusion of two or more vertebrae and short neck. We report successful tracheal intubation using the air-Q supraglottic airway device (air-Q). A 46-year-old woman (height, 149 cm; weight, 62 kg) with KFS was scheduled to undergo vertebral arch plasty for cervical spondylotic myelopathy. ⋯ Using a size 2.5 air-Q, sufficient ventilation was finally achieved. We performed fiberoptic tracheal intubation through the air-Q using a tube with an internal diameter of 6.0-mm. We then exchanged the 6.0-mm tracheal tube with a 7.0-mm spiral tube using a 10 Fr tracheal tube introducer.
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Case Reports
[Anesthetic management of a patient with Sturge-Weber syndrome associated with a giant facial hemangioma].
A 32-year old man with Sturge-Weber syndrome, a rare congenital disease of multiple angiomatous lesions including cervical cortex, face, oral soft tissues, larynx and trachea, underwent the excision of a back lipoma. His hemangioma which extended into the region of the right ophthalmic nerve and superior maxillary nerve is extremely large. He also had mental retardation and epilepsy. ⋯ He was extubated without bleeding and respiratory problems. We experienced general anesthesia of a patient with Sturge-Weber syndrome who had a giant facial hemangioma. With full-face NIPPV mask we safely induced general anesthesia.