Masui. The Japanese journal of anesthesiology
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Case Reports
[One-lung ventilation using dexmedetomidine in an emphysema patient with pneumothorax due to metastatic lung cancer].
We report a case of double-lumen tube intubation and intraoperative one-lung ventilation under spontaneous breathing with continuous dexmedetomidine administration. A 61-year-old man developed pneumothorax due to multiple metastatic cancer, had multiple bilateral bullae, and underwent bullae resection under general anesthesia. An epidural catheter was placed at T8-9. ⋯ The patient was under one-lung ventilation with spontaneous breathing during the operation. There were no complications from one-lung ventilation and the patient was extubated in the operating room. One-lung ventilation, which preserves spontaneous breathing, under dexmedetomidine sedation is considered effective for preventing barotrauma in patients with multiple metastatic cancer.
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A 67-year-old woman with rheumatoid arthritis was scheduled for lumbar anterior fusion (L5-S1). The patient had undergone several major operations on the cervical to the lumbar spine. Cervical spine movement was severely restricted, the mouth opening was limited (inter-incisor distance 3 cm), and the jaw was small (thyro-mental distance 2 cm). ⋯ At the second attempt at fiberoptic intubation a rapidly swollen larynx was observed and awake intubation was abandoned. Fiberoptic intubation could be perfomed after induction of general anesthesia. This case indicates that, although awake fiberoptic intubation is regarded as the safest and the most reliable method, this may also be associated with severe airway obstruction.
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We report the successful combined use of continuous epidural anesthesia and transversus abdominis plane block for the management of postoperative pain following a cesarean delivery in a patient whose paralysis and pain were not well controlled after two previous cesarean deliveries. A 28-year-old female patient with no remarkable medical history was scheduled to undergo cesarean delivery at 38 weeks and 3 days of pregnancy. She had undergone cesarean deliveries twice previously, at 23 and 25 years of age. ⋯ Therefore, during the third operation, the concentration of the continuous epidural anesthesia infusion was decreased to prevent complications, and a transversus abdominis plane block was added. The patient experienced no postoperative pain and fewer complications. We think that the combined use of these blocks provided good postoperative pain control with fewer complications.
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A 19-year-old male was admitted with diabetic ketoacidosis. A central venous catheter for fluid loading and insulin administration was inserted from the right femoral vein. The catheter was placed for 4days and was removal. ⋯ The surgeon also implanted an inferior vena caval filter. The patient was weaned from ventilator assist next day and was discharged from the hospital 13 days later. This case suggests that deep vein thrombosis should be checked in diabetic ketoacidosis even after removal of a central venous catheter implanted at the femoral vein.
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Despite a drastic decline in anesthesia-related morbidity and mortality, perioperative mortality remains still high with an overall rate around 1 to 2%. To improve postsurgical outcomes ultimately, anesthesiologists should move forward to take more responsibility in the perioperative management of patients. In this issue, we selected several types of highly invasive surgical procedures and reviewed anesthesia and perioperative management for the patients undergoing these surgeries. Team approach by various professionals may facilitate organizing pre-, intra-, and postoperative care.