Chang Gung medical journal
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Case Reports
Profound hypoxemia during major abdominal surgery in a small infant with tetralogy of Fallot.
We report a protracted hypoxic event during Soave's endorectal pull-through for Hirschsprung's disease in a 2-month-old male infant with tetralogy of Fallot. After the bowel loops were delivered out of the abdominal cavity, profound hypoxemia occurred which persisted for about 120 min. The hypoxemia was completely resolved after the intestine was reduced back into the peritoneal cavity. ⋯ Associated factors included hypothermia and acidosis leading to high pulmonary vascular resistance which further aggravated the right-to-left blood-shunting situation in this patient. Postoperative follow-up showed no neurological complications. Small infants with complex heart disease should be carefully evaluated before major abdominal surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of ultrasound-guided axillary brachial plexus block: a comparative study with nerve stimulator-guided method.
The aim of this study was to compare the efficacy of axillary brachial plexus block using an ultrasound-guided method with the nerve stimulator-guided method. We also compared the efficacy of ultrasound-guided single-injection with those of double-injection for the quality of the block. ⋯ Ultrasound-guided axillary brachial plexus block, using either single- or double-injection technique, provided excellent sensory and motor blockades with fewer adverse events.
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Totally implantable venous devices (TIVDs) are used increasingly in patients with cancers and other debilitating diseases requiring long-term chemotherapy, total parental nutrition, and fluid replacement. The TIVDs are surgically inserted and fixed in the soft tissues of the chest wall to prevent infection and accidental dislodgment. ⋯ Catheter fracture and cardiac migration is a rare complication and most reported cases have developed between the clavicle and the first rib as a consequence of a pinch-off sign. We present two patients with metastatic colon cancers with unusual catheter fracture site and migration and discuss the clinical implications.
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A case of low back pain syndrome was diagnosed due to spinal metastasis with unknown primary origin. During anesthesia for surgical stabilization, unexpected airway obstruction occurred after endotracheal intubation. Fiber-optic bronchoscopic examination showed narrowing of the trachea and main bronchi caused by extrinsic compression. ⋯ Airway obstruction was relieved thereafter. The extrinsic lesion was diagnosed as mediastinal lung cancer. The mechanism and management of this airway compromise caused by mediastinal tumor is discussed.
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Severe community-acquired pneumonia (CAP) is associated with high mortality. The choice of antibiotics should be guided by the distribution of bacterial pathogens. The purpose of this study was to analyze the causative bacteria and outcomes of patients with severe CAP in a medical intensive care unit (MICU) in Taiwan. The results may provide a basis of guidance for future empirical antibiotic treatments. ⋯ Gram-negative bacilli were the most-common causative pathogens among patients with severe CAP requiring mechanical ventilation. Antipseudomonal antibiotics or a carbapenem should be considered to cover Pseudomonas species, extended-spectrum beta-lactamase-producing strains, and Acinetobacter species. If the isolated bacteria are gram-positive, care should be taken to cover the possibility of ORSA. Old age and higher APACHE II scores were associated with higher mortality.