RESUMEN
PURPOSE: The pathological mechanisms of critical illness polyneuropathy (CIP), an acute neuromuscular disorder, remain unknown. In this study, we evaluated nerve and vascular properties that might account for electrophysiological abnormalities, including reduced nerve conduction amplitude, in the early phase of CIP. METHODS: Rats were administered intravenous saline (C-group; n = 31) or lipopolysaccharide (3 mg/kg/day; L-group; n = 30) for 48 h. Subsequently, tracheotomy was performed and sciatic nerves exposed bilaterally. A catheter was inserted into the left internal carotid artery to measure the mean arterial pressure (MAP). Nerve conduction velocity (NCV), nerve blood flow (NBF), evoked amplitudes, chronaxie, rheobase, and the absolute refractory period (ARP) were measured from the sciatic nerves. Degeneration, myelination, and neutrophil infiltration were examined in the sciatic nerves using histology and electron microscopy. RESULTS: The NBF (C-group 25 ± 3 ml/100 g/min, L-group 13 ± 3 ml/100 g/min, p < 0.001) was lower in the L-group, but the MAP was similar between groups (C-group 119 ± 17 mmHg, L-group 115 ± 18 mmHg, p = 0.773). LPS also caused a severe reduction in amplitude (C-group 0.9 ± 0.2 mV, L-group 0.2 ± 0.1 mV, p < 0.001), while latency and NCV were not affected. Of note, response amplitudes partially recovered with an increase in stimulus intensity. LPS treatment increased the rheobase and decreased the chronaxie (rheobase: C vs L-group; 0.35 ± 0.07 vs 1.29 ± 0.66 mA, p < 0.001; chronaxie 171 ± 24 vs 42 ± 20 µs, p < 0.001), while ARP was unchanged. No primary axonal degeneration or inflammatory infiltration was observed. CONCLUSIONS: Our findings suggest that primary electrophysiological deterioration is due to threshold alterations rather than morphological alterations after 48 h of LPS treatment.
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Inflamación/patología , Polineuropatías/fisiopatología , Sepsis/fisiopatología , Animales , Masculino , Conducción Nerviosa , Ratas , Ratas Wistar , Nervio CiáticoRESUMEN
PURPOSE: Acute kidney injury (AKI) is common after cardiovascular surgery and is usually diagnosed on the basis of the serum creatinine (SCr) level and urinary output. However, SCr is of low sensitivity in patients with poor renal function. Because urinary liver-type fatty-acid-binding protein (L-FABP) reflects renal tubular injury, we evaluated whether perioperative changes in urinary L-FABP predict AKI in the context of abdominal aortic repair. METHODS: Study participants were 95 patients who underwent endovascular abdominal aortic aneurysm repair (EVAR) and 42 who underwent open repair. We obtained urine samples before surgery, after anesthesia induction, upon stent placement, before aortic cross-clamping (AXC), 1 and 2 h after AXC, at the end of surgery, 4 h after surgery, and on postoperative days (PODs) 1, 2, and 3, for measurement of L-FABP. We obtained serum samples before surgery, immediately after surgery, and on PODs 1, 2, and 3, for measurement of SCr. We also plotted receiver-operating characteristic (ROC) curves to identify cutoff laboratory values for predicting the onset of AKI. RESULTS: With EVAR, urinary L-FABP was significantly increased 4 h after the procedure (P = 0.014). With open repair, urinary L-FABP increased significantly to its maximum by 2 h after AXC (P = 0.007). With AKI, SCr significantly increased (P < 0.001, P = 0.001) by POD 2. ROC analysis showed urinary L-FABP to be more sensitive than SCr for early detection of AKI. CONCLUSION: Urinary L-FABP appears to be a sensitive biomarker of AKI in patients undergoing abdominal aortic repair.
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Lesión Renal Aguda/etiología , Aneurisma de la Aorta Abdominal/cirugía , Procedimientos Endovasculares/métodos , Proteínas de Unión a Ácidos Grasos/orina , Anciano , Anciano de 80 o más Años , Biomarcadores/orina , Femenino , Humanos , Masculino , Periodo Posoperatorio , Estudios Prospectivos , Curva ROCRESUMEN
We report two cases of a retained guide wire after perioperative placement of a central venous catheter during a six-month period. Case 1: A 73-year-old male was scheduled for an open cholecystectomy and hepatectomy. After induction of anesthesia, a central venous (CV) catheter was inserted via the right internal jugular vein using an ultrasound guide. Chest radiographs showed a retained guide wire in the inferior vena cava immediately after surgery, which was removed by interventional radiologist before the patient emerged from anesthesia. Case 2: A 77-year-old male was scheduled for colostomy closure. The surgeon inserted a CV catheter in the right internal jugular vein 4 days before the colostomy. Chest radiographs revealed a retained guide wire in the inferior vena cava, which was removed by interventional radiologists before the patient emerged from anesthesia. Although a retained guide wire is a rare complication, awareness of this mishap is necessary to prevent it from happening.
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Cateterismo Venoso Central/efectos adversos , Cuerpos Extraños/diagnóstico por imagen , Anciano , Cateterismo Venoso Central/métodos , Humanos , Venas Yugulares , Masculino , Radiografía TorácicaRESUMEN
AIM: The aim of this study was to investigate whether the consecutive administration of recombinant thrombomodulin (r-TM) for 4 days improves maternal and fetal conditions and physiological outcomes in an N'-nitro-L-arginine-methyl ester hydrochloride-induced and low-dose endotoxin-induced pre-eclampsia (PE). METHODS: r-TM or saline was administrated i.v. to normal pregnant and experimental PE rats for 4 days. The maternal condition, vascular endothelial growth factor receptor-1 (VEGFR-1), fetal conditions, uteroplacental blood flow (UPBF), and oxygenation in the placenta and fetal brain was evaluated on gestational day 21. RESULTS: Significant increases in the mean arterial blood pressure, VEGFR-1 values and fetal death rate were observed in PE rats compared with control rats, while maternal and fetal bodyweight and fetal brain weight were substantially lower. Hypoperfusion and hypo-oxygenation in both the placenta and fetal brain tissues occurred in PE rats. Although r-TM failed to improve hypertension and affect the differences in maternal bodyweight between the groups, r-TM significantly improved hypoperfusion and fetal and maternal conditions, including VEGFR-1 values (6.5 ± 4.0 vs 2.2 ± 2.7 ng/mL, PE vs PE with r-TM, respectively; P < 0.05). Although not significant, a decrease in the fetal death rate was observed in PE rats administrated r-TM (36.1 ± 17.6% vs 25.0 ± 23.8%, P = 0.077). CONCLUSION: The severe reductions in the UPBF and the placental oxygenation imply that regional hypoperfusion occurs in association with systemic mean arterial pressure. r-TM may be a candidate medical treatment for PE complications.
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Feto/efectos de los fármacos , Preeclampsia/tratamiento farmacológico , Trombomodulina/uso terapéutico , Animales , Modelos Animales de Enfermedad , Femenino , Placenta/irrigación sanguínea , Preeclampsia/fisiopatología , Embarazo , Ratas , Ratas Wistar , Proteínas Recombinantes/uso terapéutico , Flujo Sanguíneo Regional/efectos de los fármacos , Útero/irrigación sanguíneaRESUMEN
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. Another 25 mg of levodopa was infused immediately after surgery. Twenty hours later, the patient developed tremors, heyperventilation, but no obvious muscle rigidity. Two days after surgery, the patient exhibited high fever, hydropoiesis, elevated creatine kinase, and a rise in blood leukocytes. She was diagnosed with neuroleptic malignant syndrome. She was intubated, and received dantrolene sodium. 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.
Asunto(s)
Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/cirugía , Procedimientos Quirúrgicos Cardíacos , Levodopa/administración & dosificación , Síndrome Neuroléptico Maligno/etiología , Enfermedad de Parkinson/complicaciones , Atención Perioperativa , Complicaciones Posoperatorias/etiología , Anciano de 80 o más Años , Anestesia , Dantroleno/administración & dosificación , Circulación Extracorporea/efectos adversos , Femenino , Humanos , Infusiones Intravenosas , Levodopa/sangre , Síndrome Neuroléptico Maligno/prevención & control , Síndrome Neuroléptico Maligno/terapia , Enfermedad de Parkinson/tratamiento farmacológico , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/terapiaRESUMEN
Here, we report a case of an unexpectedly complicated laryngoscopy caused by massive mandibular tori. A 64-year-old man with mitral regurgitation and aortic regurgitation was scheduled for a double valve replacement. Thyromental distance and the Mallampati score were used as predictive factors of difficult intubation, and both factors were within the normal range. Anesthesia with controlled ventilation was started with fentanyl, propofol and vecuronium. After the attainment of full muscle relaxation, an experienced anesthesiologist performed direct laryngoscopy. It was not possible to intubate the patient under direct laryngoscopy because of massive mandibular tori which had not been detected prior to induction. Following the failure of direct laryngoscopy, a McCoy laryngoscope and a gum elastic bougie were deployed to improve vision. Intubation with a 7.5 mm tube was successful at the third attempt. We hope our experience will serve as a reminder to clinicians that mandibular tori, although benign and without subjective symptoms, could have significant effects upon direct laryngoscopy by compromising the line of vision. Preoperative oral evaluation is critical and aggressive treatment should be considered.
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Anestesia , Intubación Intratraqueal/métodos , Laringoscopía , Mandíbula/anomalías , Mandíbula/patología , Insuficiencia de la Válvula Aórtica/complicaciones , Insuficiencia de la Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Laringoscopios , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/cirugía , Atención PerioperativaRESUMEN
Spinal anesthesia was performed in 40 patients undergoing cesarean section. When systolic blood pressure dropped below 100 mmHg, phenylephrine 100-200 microg (P group) or ephedrine 5-10 mg (E group) was administered. The pH of the umbilical arterial blood was collected after delivery of the baby. Apgar scores, and maternal systolic blood pressure and heart rate before and after each drug administration were compared retrospectively. The umbilical arterial pH and Apgar scores tended to be slightly higher in the P group, but there was no significant difference between the two groups. The rate of blood pressure elevation was 27% in the P group and 41% in the E group. The heart rate decreased significantly in the P group. There was no significant difference in the systolic blood pressure before administration of each drug. Recently, it is reported that the umbilical arterial pH is higher in cases in which phenylephrine is used for hypotension after spinal anesthesia during a cesarean section. However, the optimal dose of phenylephrine is debatable and has not been established. More studies are necessary to determine which drugs should be selected according to the maternal condition.
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Anestesia Obstétrica/efectos adversos , Anestesia Raquidea/efectos adversos , Cesárea , Efedrina/administración & dosificación , Sangre Fetal , Hipotensión/tratamiento farmacológico , Hipotensión/etiología , Fenilefrina/administración & dosificación , Arterias Umbilicales , Vasoconstrictores/administración & dosificación , Adulto , Puntaje de Apgar , Femenino , Humanos , Concentración de Iones de Hidrógeno , Embarazo , Estudios Retrospectivos , Adulto JovenRESUMEN
A 4-year-old girl with perforating appendicitis developed abdominal compartment syndrome (ACS). Appendicitis in children of preschool age is highly likely to rupture, resulting in serious condition. Although we gave priority to systemic management in this ACS case since the child showed disturbed consciousness due to intracranial hypertension as well as hypercytokinemic encephalopathy. However, we should have performed abdominal decompression by laparotomy early. ACS causes progressive multiple organ failure through compromising the respiratory and circulatory systems and injuring multiple organs, leading to generalized inflammatory reactions. We should, therefore, manage ACS patients systemically sharing a notion that they must be treated early with abdominal decompression by laparotomy.
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Apendicitis/complicaciones , Hipertensión Intraabdominal/etiología , Hipertensión Intraabdominal/cirugía , Apendicitis/cirugía , Preescolar , Trastornos de la Conciencia/etiología , Descompresión Quirúrgica , Urgencias Médicas , Femenino , Humanos , Hipoxia/etiología , Laparotomía , Sepsis/etiología , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
We detected congenital aqueductal stenosis from CT images taken for the differential diagnosis of a post-dural puncture headache. A history of multiple spinal taps for anesthesia and the nature of headaches led us to a suspected diagnosis of headache caused by intracranial hypotension at variance with image findings diagnostic of hydrocephalus, perplexing us in the differential diagnosis. Hydrocephalus was of congenital type, having no causal relationship with past multiple spinal taps. Congenital aqueductal stenosis varies in severity from infancy-onset one to accidental one diagnosed from images like the current case. Since treatment may differ between hydrocephalus and intracranial hypotension which are diametrically opposite to each other in pathophysiology, it is essential to differentiate a headache in an overall view of a history, physical examination, and image findings.
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Hidrocefalia/congénito , Hidrocefalia/diagnóstico por imagen , Cefalea Pospunción de la Duramadre/diagnóstico , Tomografía Computarizada por Rayos X , Adulto , Diagnóstico Diferencial , Femenino , HumanosRESUMEN
BACKGROUND: Although remifentanil produces respiratory depression, its very short duration of action provides a great advantage for the control of hemodynamics during anesthesia for tracheobronchial stent insertion. We compared remifentanil with fentanyl during propofol-based anesthesea for anesthetic management for tracheobronchial stent insertion. METHODS: Seventy-eight patients were analyzed retrospectively by anesthetic chart review. Thirty-nine patients were anesthetized with bolus infusion of fentanyl with propofol (group PF). The remaining 39 patients were anesthetized with continuous infusion of remifentanil with propofol (group PR). Demographic data, duration of anesthesia and operative procedure, airway management, duration of emergence, dose of propofol, fentanyl and remifentanil, and use of cardiovascular drug were analyzed for the 2 groups. Chi-square tests and Student-t test were used for statistical analysis. Differences were considered significant when P was below 0.05. RESULTS: The dose of propofol was less in the PR group than in the PF group (0.10 +/- 0.04 mg x kg(-1) x min(-1) vs. 0.14 +/- 0.04 mg x kg(-1) x min(-1), P = 0.025). The duration of emergence was shorter in the PR group than in the PF group (9.0 +/- 6.8 min vs. 12.5 +/- 6.2 min). CONCLUSIONS: We conclude that the continuous infusion of low dose remifentanil with propofol produce more efficient respiratory and hemodynamic stability than the bolus infusion of fentanyl with propofol during anesthesia for tracheobronchial stent insertion.
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Anestesia Intravenosa , Anestésicos Combinados , Piperidinas , Stents , Adulto , Anciano , Bronquios , Femenino , Fentanilo/administración & dosificación , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Piperidinas/administración & dosificación , Propofol/administración & dosificación , Remifentanilo , Respiración , Estudios Retrospectivos , TráqueaRESUMEN
A 25-year-old healthy woman was scheduled for enucleatic myomectomy under combined epidural and general anesthesia. During insertion of a lumbar epidural catheter, sudden loss of consciousness associated with asystole developed. This condition was quickly restored by rapid fluid infusion, administration of atropine sulfate (0.5 mg) and oxygen (6l x min(-1)). Diagnosis of neurocardiogenic syncope (NCS) was made by previous episodes of fainting revealed at that point. An epidural catheter was placed under sedation with midazolam 2 mg. Surgery was performed uneventfully under sevoflurane anesthesia. Since NCS occurs recurrently in a susceptible individual, it is important to identify previous syncopal episode preoperatively. If such an event is anticipated, prevention including proper communication to reduce patient's anxiety, careful vigilance on both patient and monitor during procedure, gentle maneuver to reduce pain and use sedative and/or anticholinergic agents must be considered.
Asunto(s)
Anestesia Epidural , Anestesia General , Ansiedad/complicaciones , Paro Cardíaco/etiología , Complicaciones Intraoperatorias/etiología , Síncope Vasovagal/etiología , Adulto , Atropina/administración & dosificación , Femenino , Fluidoterapia , Paro Cardíaco/prevención & control , Humanos , Cuidados Intraoperatorios , Complicaciones Intraoperatorias/prevención & control , Midazolam , Monitoreo Intraoperatorio , Síncope Vasovagal/prevención & controlRESUMEN
BACKGROUND: We retrospectively examined the effect of remifentanil on urine output during gynecological laparoscopic surgery under general anesthesia performed from April 2006 to July 2007. METHODS: Forty six patients undergoing gynecological laparoscopic surgery under general anesthesia were divided into 2 groups. In group C (n=23), anesthesia was performed using sevoflurane and/or propofol with intermittent fentanyl. In group R (n=23), remifentanil was additionally used with the method of group C. RESULTS: Patient's demography was not different between the two groups. Intraoperative conditions were compatible in both groups. In group R, total dose of fentanyl is significantly lower than group C. BP and HR measured at 20 min after pneumoperitoneum were significantly lower in group R. Intraoperative urine output was significantly greater in group R than group C. CONCLUSIONS: A decrease in urine output is commonly seen particularly in laparoscopic surgery. Increased stress hormonal responses due to pneumoperitoneum have been explained as one of the causes of this phenomenon. Remifentanil has been reported to maintain urine output as well as to blunt hormonal responses in CABG surgery. Although we did not measure hormonal responses in the present study, increased urine output could be attributed to decreased catecholamine levels by remifentanil.
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Anestesia General , Procedimientos Quirúrgicos Ginecológicos , Laparoscopía , Piperidinas , Micción/efectos de los fármacos , Adulto , Femenino , Humanos , Periodo Intraoperatorio , Piperidinas/farmacología , Neumoperitoneo , Remifentanilo , Estudios Retrospectivos , Adulto JovenRESUMEN
A 69-year-old man was scheduled for combined surgery involving off-pump coronary artery bypass grafting (OPCABG) for coronary stenosis and total pneumonectomy for lung cancer. Anesthesia was maintained with fentanyl, thiopental, sevoflurane, nitrous oxide, and epidural anesthesia using 1.0% mepivacaine. Although a steady hemodynamic circulation was maintained during OPCABG, it was difficult to stabilize the circulation during the total pneumonectomy.
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Anestesia Epidural , Anestesia por Inhalación , Puente de Arteria Coronaria Off-Pump , Neoplasias Pulmonares/cirugía , Neumonectomía , Anciano , Estenosis Coronaria/cirugía , Hemodinámica , Humanos , MasculinoRESUMEN
We report a case of exostosis of the hard palate which had not bean ruled out in pre-operative examination and disturbed insertion of Pro-Seal laryngeal mask. The hard palate has canopy construction, and it is difficult to find this exostosis by routine physical examination. When we use Pro-Seal laryngeal mask, a careful inspection of the hard palate is indispensable.
Asunto(s)
Exostosis , Máscaras Laríngeas , Paladar Duro , Anestesia General , Neoplasias de la Mama/cirugía , Exostosis/diagnóstico , Femenino , Humanos , Mastectomía Segmentaria , Persona de Mediana EdadRESUMEN
We report management of anesthesia in a patient suffering from glucose-6-phosphate dehydrogenase (G6PD) deficiency, a condition that induces acute hemolysis when associated with surgical stress and infection, or following the application of oxidant drugs. A 5 year-old-male patient, suffering from G6PD deficiency was scheduled for laparoscopic cholecystectomy. The patient had exhibited signs of hemolysis during the course of various infections and after ingesting fava beans (favism). Anesthesia was induced with midazolam and vecuronium and maintained with nitrous oxide in oxygen and sevoflurane. There was no hemolytic change during the perioperative period. It was clear that this combination of drugs provided safe anesthesia for the G6PD patient in the present study. The most important considerations for patients with G6PD deficiency is firstly, the avoidance of oxidative stress, which can be caused by a variety of different conditions, and secondly, the use of anti-oxidative anesthetic drugs.
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Anestesia , Colecistectomía Laparoscópica , Cálculos Biliares/cirugía , Deficiencia de Glucosafosfato Deshidrogenasa , Antioxidantes/administración & dosificación , Preescolar , Hemólisis , Humanos , Masculino , Estrés OxidativoRESUMEN
May-Hegglin anomaly (MHA) is a rare hereditary disorder characterized by thrombocytopenia and giant thrombocytes and continuous appearance of inclusion bodies (Dohle like corpuscles) in the cytoplasm of granulocytes. A 26-year-old woman with MHA underwent cesarean delivery under general anesthesia, although she had no history of bleeding. The platelet count was 4.9x10(4) microgl(-1) the day before surgery. There was no unusual bleeding during and after the operation and we did not give her platelet transfusion.
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Anestesia General , Anestesia Obstétrica , Plaquetas/patología , Cesárea , Granulocitos/ultraestructura , Cuerpos de Inclusión/patología , Complicaciones Hematológicas del Embarazo , Trombocitopenia , Femenino , Humanos , Atención Perioperativa , Recuento de Plaquetas , Embarazo , Resultado del EmbarazoRESUMEN
PURPOSE: For anesthetic management of cesarean sections, regardless of the use of regional or general anesthesia, it is crucial to achieve sufficient uterine contraction immediately following the delivery of an infant in order to reduce excessive bleeding. No previous study has investigated the ability of alprostadil, a synthesized prostaglandin, to inhibit myometrial relaxation induced by volatile anesthetics. The aim of the present study was to investigate the inhibitory effects of alprostadil on sevoflurane-induced myometrial relaxation using myometrial strips isolated from pregnant rats. METHODS: Myometrial strips were isolated from Sprague-Dawley rats (300-400 g) in the late stage of gestation (19-21 days). The time course of changes in spontaneous myometrium contraction was studied in the presence and absence of sevoflurane. Additionally, alprostadil was titrated at three different concentrations during continuous introduction of sevoflurane 2%, and myometrium contraction was studied. As an index of contraction, the area under the contraction curve was used, and data were analyzed by repeated measure one-way analysis of variance. RESULTS: We have shown a significant decrease in myometrium contraction as a result of the use of sevoflurane (2%). Additionally, alprostadil has been shown to inhibit myometrial relaxation induced by sevoflurane in a dose-dependent manner. The areas under the contraction curve were 87%, 87%, 129%, and 172% of the baseline value for the control and at low, medium, and high concentrations of alprostadil, respectively. CONCLUSION: The ability of alprostadil to inhibit myometrial relaxation induced by sevoflurane suggests that the use of alprostadil during general anesthesia for cesarean section may be advantageous for the reduction of postpartum bleeding.
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Alprostadil/farmacología , Anestésicos por Inhalación/antagonistas & inhibidores , Éteres Metílicos/antagonistas & inhibidores , Relajación Muscular/efectos de los fármacos , Miometrio/efectos de los fármacos , Vasodilatadores/farmacología , Animales , Área Bajo la Curva , Relación Dosis-Respuesta a Droga , Femenino , Relajación Muscular/fisiología , Miometrio/fisiología , Reacción en Cadena de la Polimerasa , Embarazo , Ratas , Ratas Sprague-Dawley , Sevoflurano , Contracción Uterina/efectos de los fármacosRESUMEN
BACKGROUND: To determine perioperative complications, we evaluate herein 10 cases of anesthetic management for placement of Dumon stent in patient with tracheal or bronchial stenosis due to invasion of esophageal or lung cancer. METHODS: After sufficient oxygenation, anesthesia was induced with propofol and fentanyl. Since muscle relaxant has been considered safe for central-type air way stenosis except for cases involving large anterior mediastinal masses, we administered vecuronium for all cases to facilitate insertion of rigid bronchoscope and for surgical procedures. Anesthesia was maintained with continuous infusion of propofol, and ventilation was performed via a side-port of a rigid bronchoscope with 100% oxygen. Extra corporeal circulation was instituted in 2 cases. RESULTS: In 5 of the 10 cases, stent placement was uneventful. However, in the other 5 cases, respiratory failure (SpO2 < 90% and/or PaCO2 > 80 mmHg: 4 cases) or severe hypotension (systolic blood pressure < 60 mmHg: 3 cases) developed. Severe hypotension was attributed to relatively higher dose of anesthetic agents for cachexic status, or reduction in venous return following over-inflation of the lungs. Acute reduction in blood carbon dioxide levels due to extracorporeal circulation (case 4), and loss of consciousness after administration of anesthetic agents (case 2) could also have been involved in 2 cases. CONCLUSIONS: Circulatory status must be closely monitored during anesthetic management for Dumon stent placement.
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Anestesia General/métodos , Enfermedades Bronquiales/cirugía , Stents , Estenosis Traqueal/cirugía , Anciano , Enfermedades Bronquiales/etiología , Constricción Patológica , Neoplasias Esofágicas/complicaciones , Femenino , Humanos , Neoplasias Pulmonares/complicaciones , Masculino , Persona de Mediana Edad , Estenosis Traqueal/etiologíaRESUMEN
In cases of hydrops foetalis, respiratory management is frequently required after delivery. We experienced 7 anesthetic managements for cesarean section in patients with hydrops foetalis. Spinal anesthesia was performed in 3 patients, because the transition of local anesthesia through the placenta was little. On the other hand, general anesthesia was performed in 4 patients because of babies requiring endotracheal intubation or fetal anesthesia immediately after a delivery. Before surgery, we discussed perioperative and anesthetic management among pediatricians, pediatric surgeons, and obstetricians in a conference. Since the anesthetic drugs used for the cesarean section have great influences on the fetus, the choice of anesthesia should be performed based on fetal conditions.
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Anestesia General , Anestesia Obstétrica/métodos , Anestesia Raquidea , Cesárea , Hidropesía Fetal , Adulto , Femenino , Humanos , Embarazo , PronósticoRESUMEN
PURPOSE: The aims of the present study were (1) to investigate if a disposable patient-controlled analgesia (PCA) device can be used for labor analgesia and (2) to evaluate the device by midwives and parturients. METHODS: Forty healthy parturients were divided into two groups and received combined spinal epidural analgesia for labor pain relief. Following intrathecal administration of 3 mg ropivacaine and 1.5 microg sufentanil, either a disposable PCA device (Coopdech Syrinjector; Daiken Medical, Osaka, Japan) or an electronic PCA device (IVAC PCAM PCA Syringe Pump; Alaris, Basingstoke, UK) was connected to the epidural catheter, and 0.15% ropivacaine with sufentanil 0.75 microg/ml was used for continuous infusion and PCA. For an electronic PCA device, continuous infusion rate, bolus dose, lockout time, and hourly limit were set at 4 ml/h, 3 ml, 15 min, and 16 ml, respectively. For a disposable PCA device, continuous infusion rate, bolus dose, and an hourly limit were set at 4 ml/h, 3 ml, and 16 ml, respectively, but lockout function was not available. RESULTS: No differences were observed between the groups concerning demographic data, obstetric data, and outcome of labor. Anesthetic requirements (disposable, 9.7 +/- 4.7 ml/h; electronic, 8.2 +/- 4.0 ml/h) and VAS score during the delivery (disposable, 26 +/- 25; electronic, 21 +/- 22) were similar between the groups. Midwives praised the disposable PCA device as well as the electronic one. CONCLUSION: The present results imply that the disposable PCA device can be an alternative to the electronic PCA device for labor analgesia.