Masui. The Japanese journal of anesthesiology
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Case Reports
[Anesthetic management of a patient with severe subcutaneous and mediastinal emphysema due to pertussis infection].
A 20-month-old girl, with respiratory failure due to severe subcutaneous and mediastinal emphysema, was scheduled to undergo percutaneous drainage of emphysema and induction of extracorporeal membrane oxygenation. Paroxysm, a symptom of the infection of Bordetella pertussis, was the cause of emphysema. In patients with severe neck subcutaneous emphysema, management of difficult airway is the most important safety issue in the practice of anesthesia. ⋯ Combined with propofol and midazolam, pethidine was an effective agent for safe anesthetic induction because it produces less respiratory depression compared to other opiate analgesics. In conclusion, this case demonstrates the importance of prediction of and preparation for difficult airway. Furthermore, anesthesiologists should consider the optimization of anesthesia to avoid progression of emphysema.
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Few studies have examined the perioperative status of dual antiplatelet therapy and postoperative thrombotic or bleeding complication rates of patients undergoing non-cardiac surgery with recent history of coronary stent implantation. ⋯ In the present study, bleeding complications requiring transfusion were frequently observed in patients with dual antiplatelet therapy undergoing non-cardiac surgery, whereas perioperative therapy discontinuation did not trigger thrombotic complications including stent thrombosis.