Masui. The Japanese journal of anesthesiology
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Case Reports
[Anesthesia for open reduction of ankle fracture in a patient with giant pituitary adenoma].
A few cases of the pituitary apoplexy have been reported after spinal anesthesia in patients with pituitary tumor. A patient with giant pituitary adenoma underwent open reduction of the ankle fracture. ⋯ The surgery was successfully done without any complications and the patient was discharged uneventfully 25 days after surgery. When patient has a giant pituitary tumor, peripheral nerve block might be a good choice for anesthesia.
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Aortocaval fistula is a rare complication of ruptured abdominal aortic aneurysm. We report anesthetic management of a patient with aortocaval fistula caused by rupture of a huge abdominal aortic aneurysm into the inferior vena cava. A 51-year-old man who had complained of low back pain and general fatigue was referred to our hospital because of his liver damage. ⋯ After the repair of the aortocaval fistula, the hemodynamics became stable. The patient had a high output but a good cardiac function in preoperative examination. Therefore anesthesia was managed successfully without worsening high-output heart failure.
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An 80-year-old woman with Parkinson's disease was scheduled for open heart surgery to repair thoracic aortic aneurysm. Parkinson's symptoms were normally treated using oral levodopa (200 mg), selegiline-hydrochloride (5 mg), bromocriptine-mesilate (2 mg), and amantadine-hydrochloride (200 mg) daily. On the day before surgery, levodopa 50mg was infused intravenously. ⋯ Symptoms of neuroleptic malignant syndrome disappeared on the fourth postoperative day. The stress of open heart surgery, specifically extracorporeal circulation and concomitant dilution of levodopa, triggered neuroleptic malignant syndrome in this patient. Parkinson's patients require higher doses of levodopa prior to surgery to compensate and prevent neuroleptic malignant syndrome after surgery.
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A 39-year-old man with a history of transsphenoidal surgery was scheduled for sagittal split ramus osteotomy. Nasal intubation was successfully performed using a bronchoscope (BF) and a gum elastic bougie (GB). inserted using a BE The BF was then replaced with a GB. ⋯ Finally, intubation was performed with an endotracheal tube (7.0 mm) using a GB and a Macintosh laryngoscope. Thus, BF and GB could be safely used for nasal intubation in a patient with a history of transsphenoidal surgery.
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Meta Analysis
[Efficacy of videolaryngoscopes for nasotracheal intubation: a meta-analysis of randomized controlled trials].
Increased evidence indicates that the videolaryngoscope is useful for nasotracheal intubation. The aim of this meta-analysis is to assess the efficacy of videolaryngoscopes (Glidescope, Airtraq and Pentax-AWS) in nasotracheal intubations, comparing with that of Macintosh laryngoscopy. ⋯ Our meta-analysis showed that the videolaryngoscope has an advantage over Macintosh laryngoscope in nasotracheal intubations.