Masui. The Japanese journal of anesthesiology
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Laparoscopic procedures are considered relatively low-invasive. However, there exists a small but important risk of developing complications related to carbon dioxide (CO2) insufflation. End-tidal CO2 (PetCO2) monitoring may not be a sufficient guide to adjust pulmonary ventilation during laparoscopic surgery, and arterial CO2 (PaCO2) monitoring is not always indicated. We evaluated the accuracy and feasibility of transcutaneous CO2 (PtcCO2) monitoring during laparoscopic surgery. ⋯ The transcutaneous devices provide an effective method for non-invasive monitoring of PCO2 in situations where continuous monitoring of CO2 levels is desired such as peri-operative period of laparoscopic surgery.
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We report two cases of the rhabdomyolysis of the erector spine muscles occurring after nephrectomy in lateral flexed decubitus position. Case 1. A 39-year-old man (170-cm, 85-kg) underwent right nephrectomy for a right renal tumor. ⋯ Fortunately the patient did not develop renal failure. Direct, prolonged pressure on the paravertebral muscle was the etiology of rhabdomyolysis in our cases. Although our cases were not severe and the complications were not induced, it must be kept in mind that excessive pressure in a limited area can damage the muscle during prolonged surgery.
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A 5-month-old boy was diagnosed as having complete atelectasis of the right lung due to RS virus infection at the age of 1 month. Conventional respiratory physical therapy, inhalation therapy and mechanical ventilation through an endotracheal tube failed to re-expand the right lung, while the left lung gradually became overinflated. We therefore tried differential lung ventilation by using a combination of a laryngeal mask airway and an extra long endotracheal tube (ID, 3.5 mm; length, 280 mm; Portex Pediatric Tracheal Tube, Extra length; SIMS Portex Co., Ltd. ⋯ The right lung was selectively lavaged and inflated with high pressure while ventilation was maintained through the laryngeal mask airway. The SpO2 value was maintained at more than 95% throughout the procedure despite some leakage from the ventilation system. The case demonstrates that differential lung ventilation by use of a combination of a laryngeal mask airway and extra long endotracheal tube is useful for the treatment of a pediatric patient with severe atelectasis.
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Case Reports
[Anesthetic management for cerebral aneurysm surgery in a patient with aortitis syndrome accompanied by lung edema].
A 48-year-old woman with aortitis syndrome underwent clipping of dissecting aneurysm of the left posterior inferior cerebellar artery following subarachnoid hemorrhage. Preoperative echocardiography demonstrated moderate aortic regurgitation and pulmonary hypertension. Intravenous infusion (1900 ml.day-1) was performed to avoid cerebral vasospasm, but the patient developed lung edema. ⋯ Anesthesia was maintained with sevoflurane, air, and oxygen. We continuously monitored the central venous pressure as an indicator of fluid balance. In this case, we monitored dorsal pedis arterial pressure directly, which might not be sufficiently reliable to predict the decrease in cerebral blood flow.
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Case Reports
[False decrease in pulse oximetry readings due to patent blue in a patient with breast cancer].
A 61-year-old woman with breast cancer was scheduled for breast preserving therapy under general anesthesia. After the tracheal intubation, 4 ml of 2% patent blue was injected into the skin to determine sentinel lymph node. Thirty seconds after injection, the pulse oximetry reading (SpO2) decreased from 100% to 60% and recovered to 90% over the next 5 minutes. ⋯ The operation was completed uneventfully and the patient recovered from anesthesia smoothly. After extubation, arterial blood gas analysis was performed again and it showed PaO2 of 82.5 mmHg (FIO2 0.21). We conclude that patent blue injection caused this decrease in SpO2 and recommend to evaluate the oxygen status not only by pulse oximetry but also by blood gas analysis when patent blue is used.