Masui. The Japanese journal of anesthesiology
-
Complete tracheal ring causes congenital tracheal stenosis in neonates and infants. We have to prevent further tracheal stenosis in perioperative period. This is a case report of an infant with congenital tracheal stenosis due to complete tracheal ring who underwent primary cleft lip closure under general anesthesia. ⋯ He was discharged on 8 POD without complication. CT scan and its integrated 3 D image of the trachea were useful to understand the approximate structure. However endoscopic examination allowed more detailed structure-measurement below glottis.
-
Here we report successful rapid-sequence inubation with the McGRATH MAC videolaryngscope (McGRATH) in the face to face sitting position for a patient with severe ileus and restricted mouse opening. A 46-year-old woman with advanced bladder cancer had developed ileus. Ileus tube and octreotide did not relieve her symptoms, and emergency colostomy was planned. ⋯ First an anesthesiologist stood at face to face position to the patients, and the second anesthesiologist kept the head of the patient from the cranial side. After thiamylal and fentanyl administration, cricoid pressure was applied by the third anesthesiologist. Under the guide of the McGRATH's monitor, we could successfully insert the 7.0 mm internal diameter tracheal tube with a stylet uneventfully in the face to face sitting position.
-
Intraoperative monitoring of train-of-four (TOF) response is recommended to avoid inadequate dose of muscle relaxant and its antagonist. We have standardized monitoring of TOF response at the end of surgery in all the patients undergoing general anesthesia with rocuronium since October 2013. ⋯ We conclude that standardization of TOF response at the end of surgery reduces dose of sugammadex in patients with slight residual neuromuscular block though the dose in patients under deep muscle relaxation seems to be insufficient.
-
We report a case of successful pulsed radiofrequency stimulation of the sciatic nerve for intractable cancer pain caused by sacral bone metastasis of non-small cell lung cancer. A 57-year-old man who suffered from intractable left femoral pain was diagnosed with cancer metastasis to the sacral bone and lumbar spine. Oral oxycodone relieved the pain at rest but he could not walk or remain sitting due to the pain during exercise. ⋯ Given that sciatic nerve block with mepivacaine was effective, we performed pulsed radiofrequency with ultrasound guidance twice. Pulsed radiofrequency relieved the left femoral pain and he could sit for hours and walk uneventfully. Our finding suggest that ultrasound-guided pulsed radiofrequency of the sciatic nerve effectively relieves intractable left femoral pain caused by sacral bone metastasis.
-
Case Reports
[A Case of Repetitive Cardiac Arrest due to Coronary Vasospasm after Sugammadex Administration].
A 58-year-old man with no history of cardiac disease was scheduled for a cerebral aneurysm clipping surgery. Anesthesia was administered with propofol, rocuronium, fentanyl, and remifentanil. At the end of the surgery, extubation was performed 3 min after the administration of 200 mg sugammadex, along with a simultaneous blood-pressure decrease with ST elevation on lead II. ⋯ An acetylcholine provocation test performed later showed positive results. We suspect sugammadex to be the cause of coronary vasospasm, because the time courses of the two cardiac arrest episodes after sugammadex administration were very similar. Therefore, clinicians should consider sugammadex as one of the causative agents of cardiac arrest in the operating room.