Masui. The Japanese journal of anesthesiology
-
Case Reports
[A case of delayed arousal after anesthesia due to aberrant epidural catheter placement in a blood vessel].
A 71-year-old man underwent a total gastrectomy. An epidural catheter was inserted before the induction of general anesthesia. Blood was withdrawn from an epidural catheter inserted at T8-9 interspace with a median approach. ⋯ When we carefully aspirated the epidural catheter, fresh blood was withdrawn from the catheter. We confirmed that the delayed arousal was due to the administration of ropivacaine into the blood by aberrant epidural catheter placement in a blood vessel. Unaccountable tachycardia and mild hypertension observed persistently during the operation would have been the warning to the toxicity of local anesthetics during general anesthesia.
-
This article introduces the equipment used for epiduroscopy and describes its indications, procedures for use, treatment outcomes, the potential complications and future developments. Epiduroscopy is used in the treatment and diagnosis of intractable low back and leg pain in patients in whom nerve block is not efficacious and when pain recurs after operation. The characteristics of epiduroscopy are that it is: 1) safe and less invasive; 2) used for endoscopic washing of the epidural space and fluoroscopic X-ray; 3) it allows injection of an agent into the lesion; and 4) it results in no change in the normal lumbar structure after operation. Epiduroscopy is expected to provide successful outcomes for many patients with intractable low back and leg pain through further improvements in equipment related to epiduroscopy, advances in technology, the accumulation of data regarding its efficacy and safety, and the coverage of treatment by insurance.
-
In order to secure airway during awake craniotomy, we used i-gel to perform positive-pressure ventilation in 7 patients for their anesthetic management. During removal of a tumor around the motor speech center, anesthetic management including asleep-awake-asleep technique was applied for speech testing. ⋯ Leakage around i-gel, and its differences between inspiration and expiration were negligible, while the tidal volume was adequate. We conclude that i-gel is useful for anesthetic management for awake craniotomy procedure for both securing airway and ventilation.
-
We report a case of successful one-lung ventilation with a spiral-tipped double lumen tube for resection and reconstruction of the tracheal bifurcation. A 71-year-old woman with lung cancer developed its invasion to the right bronchus near the tracheal bifurcation. Right lung total pneumonectomy or reconstruction with resection of the tracheal bifurcation was planned. ⋯ The tracheal tube was exchanged with a spiral-tipped double lumen tube under bronchofiberscopy and one-lung ventilation was achieved. Total pneumonectomy and reconstruction of the tracheal bifurcation proceeded uneventfully. One-lung ventilation with a spiral-tipped double lumen tube may be useful in tumor resection that involves distorted anatomy, such as at tracheal bifurcation.
-
We present a case of anticipated difficult airway with severe rheumatoid arthritis in which intubation with fiberoptic bronchoscope (FOB) assisted by Pentax-AWS Airwayscope with the thin Intlock (AWS T) was effective. A 69-year-old woman was scheduled to undergo laparoscopic cholecystectomy for acute cholecystitis in a previous hospital. Tracheal intubation with Glidescope or nasal intubation was unsuccessful and abandoned due to mucosal injury and bleeding. ⋯ We planned to perform tracheal intubation preserving spontaneous breathing under intravenous administration of dexmedetomidine and fentanyl. We could visualize the epiglottis, but could not set the target mark to the invisible glottis with AWS-T. Finally, we could accomplish uneventful tracheal intubation with FOB along with the Intlock's guides of AWS-T.