RESUMEN
BACKGROUND: General anesthesia for tracheal stenting is challenging because of difficult ventilation and accompanying hypoxia. We report the use of oxygen reserve index (ORi™) during tracheal stenting. CASE PRESENTATION: Cauterization of an intratracheal tumor and tracheal stenting was scheduled in a patient. ORi decreased from 0.3 to 0.2 after starting cauterization using a flexible bronchoscope through a tracheal tube with 28% oxygen, while SpO2 was maintained at 100%. ORi further decreased to 0, followed by a decrease of SpO2 < 90%, and surgery was interrupted. SpO2 was increased shortly after increasing FiO2 to 1.0, but ORi remained 0 when surgery was resumed; it was increased after completion of cauterization. Both ORi and SpO2 were maintained above 0.4 and 98%, respectively, during tracheal stenting through a rigid bronchoscope under intrapulmonary percussive ventilation. CONCLUSION: ORi was useful for predicting a decrease of SpO2 under general anesthesia for tracheal stenting.
RESUMEN
A 29-year-old man suspected of having a hematopoietic malignancy was scheduled to undergo video- assisted splenectomy. Because of his good general con- dition on a preanesthetic evaluation, combined general and epidural anesthesia was selected. However, after insertion of an epidural catheter in the operating room, surgery had to be postponed due to bleeding from the catheter insertion site. The hematological examination done right after the postponement revealed hemo- phagocytic syndrome and the patient rapidly developed disseminated intravascular coagulation. This case suggested that in a patient with hematopoietic malig- nancy a hematological examination should be carried out on the day of surgery; besides, neuraxial blockade should be avoided because bleeding could be acutely induced due to changes in the patient's condition.
Asunto(s)
Procedimientos Quirúrgicos Electivos , Neoplasias Hematológicas/cirugía , Hemorragia/etiología , Adulto , Anestesia Epidural , Coagulación Intravascular Diseminada , Neoplasias Hematológicas/complicaciones , Humanos , MasculinoRESUMEN
An 83-year-old woman was admitted to our hospital with fracture of the T11 vertebral body and paraplegia. Complications included ankylosing spondylitis and osteoporosis. The vertebra was acutely deviated and thus at risk of being crushed had manual correction of the dislocation been attempted. Instead, we predicted that placing the patient in an appropriate posture during surgery would allow the dislocation to correct spontaneously. Three possible postures were proposed by the orthopedic surgeon at a conference that was also attended by operative nurses. A Hastings posture was finally used intraoperatively. No complications arising from the posture itself were noticed during or after surgery. We concluded that a preoperative conference among doctors and nurses can eliminate unnecessary confusion in cases when special postures are utilized during surgery.