Masui. The Japanese journal of anesthesiology
-
After total correction of tetralogy of Fallot, pulmonary atresia and major aorto-pulmonary collateral arteries, a 31-year-old man developed life-threatening pulmonary hypertension and reperfusion pulmonary edema, leading to pulmonary hemorrhage, right heart failure and hypoxia. Because of difficulty in weaning from cardiopulmonary bypass and in controlling hemorrhage from pulmonary arteries, we applied percutaneous cardiopulmonary support (PCPS) for 281 hours with strategy of delayed sternal closure (17 days) and a large quantity of transfusion. ⋯ As the result, he was discharged alive without any major complications. We report our postoperative managements, in terms of 1) lung protective ventilatory strategy, 2) surgical control of pulmonary blood flow, and 3) evaluation of the cardiopulmonary function during PCPS for early weaning from PCPS.
-
We report here a case of obstruction of an reinforced endotracheal tube during laryngomicrosurgery under total intravenous anesthesia. In this case, we used a 6.0 mm ID reinforced endotracheal tube that had been used previously for other patients and sterilized two times by ethylene oxide gas. During the operation, the peak airway pressure increased gradually and eventually reached to 35 cmH2O. ⋯ Several cases of reinforced tube obstruction have already been reported and in most of these cases the obstruction was related to their repeated use and nitrous oxide anesthesia. However, the present case showed that dissection of reinforced endotracheal tube could also occur during general anesthesia without using nitrous oxide. We should bear in mind that repeated use of reinforced endotracheal tube could induce a critical airway obstruction.
-
A 68-year-old male patient was referred to our hospital for his intractable and progressive dyspnea. Chest roentgenography and computerized tomography revealed severe lower tracheal stenosis due to neoplastic invasion. The tumor completely surrounded his trachea for 5 cm length and the remaining internal diameter of the trachea was less than 5 mm. ⋯ Following chemotherapy and radiotherapy were so effective that the endotracheal tube was extubated two weeks later uneventfully. After several series of chemotherapy and 50 Gy irradiation, the patient was discharged three months later without symptoms. We concluded that CAEC could be one of the life-saving instruments for emergent airway management in case of severe organic tracheal stenosis.
-
Case Reports
[Laparoscopic cholecystectomy under general anesthesia for a woman in the 28th week of gestation].
Anesthesia for laparoscopic cholecystectomy under hypobaric pneumoperitoneum was given to a pregnant woman in 28th week of gestation. Anesthesia was induced by administering thiopental(5 mg.kg-1) and vecuronium (0.1 mg.kg-1). The lungs were artificially ventilated with oxygen, nitrous oxide, and low concentrations of sevoflurane to maintain the end-expiratory CO2 pressure at 30 to 35 mmHg. ⋯ Mother's blood gases and the fetal heart beat monitored with the abdominal supersonic wave stayed steady through the perioperative periods. The pneumoperitoneum time was 34 minutes and the operation time was 40 minutes without any troubles. But we should pay much attention to anesthesia and operation in any pregnant patient.
-
Serious side effects of postoperative analgesia with opioid drugs include nausea and vomiting. ⋯ Consideration should be given to gender and smoking status prior to starting preventive antiemetic therapy using PCA with fentanyl following cervical spine surgery.