ABSTRACT
This report describes the perioperative management of an adrenergic crisis and intraoperative pulmonary edema occurring during planned surgery for pheochromocytoma. We experienced the anesthetic management of a 45-year-old male patient with pheochromocytoma on the extra-adrenal retroperitoneum. The patient had been treated with prazosin for only 1 week before surgery. After inducing anesthesia with intravenous remifentanil, thiopental sodium, and rocuronium, anesthesia was maintained with nitrous oxide, oxygen, and isoflurane administration. The blood pressure was poorly controlled with sodium nitroprusside, esmolol, and remifentanil after manipulating the tumor. Pulmonary edema occurred intraoperatively but subsided with positive end expiratory pressure and the use of diuretics and morphine. After removing the tumor, the blood pressure was well controlled using a colloid solution, Hartman's solution, and dopamine administration. This complication occurred because of inadequate preoperative preparation. We reported this case of surgery for the removal of a pheochromocytoma with a review of the relevant literature.
Subject(s)
Humans , Male , Middle Aged , Anesthesia , Blood Pressure , Colloids , Diuretics , Dopamine , Isoflurane , Morphine , Nitroprusside , Nitrous Oxide , Oxygen , Pheochromocytoma , Positive-Pressure Respiration , Prazosin , Pulmonary Edema , ThiopentalABSTRACT
Subglottic stenosis can be caused by various etiology such as idiopathic, infectious disease, trauma from previous prolonged intubation, airway surgery, external blunt trauma, radiaton, or inhalation burn. Although extremely rare, subglottic stenosis may be present in pregnancy and engender a complex and technically challenging dilemma for anesthesiologist as how to evaluate and best manage these patients. A 36-year-old parturient was scheduled for Cesarean section. When most of the vocal cords were exposed clearly by laryngoscopy after injection of thiopental sodium & succinylcholine, the 7.0 mm internal diameter (ID) endotracheal tube could not be advanced below the level of the vocal cords because of resistance. So, intubation was re-attempted several times after oxygenation by mask with smaller tubes. Finally, a 6.0 mm ID cuffed tube was passed successfully through the vocal cords, and secured in place. because of the unexpected difficulties in intubation, an otolaryngologist was consulted to examine the larynx with a microscope. We present an unexpected case of the difficult endotracheal intubation caused by a unrecognized subglottic stenosis in a preeclamptic who underwent the induction of general anesthesia for Cesarean section.
Subject(s)
Adult , Female , Humans , Pregnancy , Anesthesia, General , Burns, Inhalation , Cesarean Section , Communicable Diseases , Constriction, Pathologic , Intubation , Intubation, Intratracheal , Laryngoscopy , Larynx , Masks , Oxygen , Pre-Eclampsia , Succinylcholine , Thiopental , Vocal CordsABSTRACT
Hundreds of drugs have been implicated as the causes of antibody-mediated thrombocytopenia. Naproxen is a commonly used nonsteroidal anti-inflammatory drug, and it is generally considered to be safe with few hematological side effects such as thrombocytopenia. In this case, severe thrombocytopenia associated with petechia and epistaxis appeared after initiation of naproxen therapy in the 59-year-old man. We report here on a case of severe thrombocytopenia that was recognized at 10 days after the use of naproxen, and the patient rapidly recovered to a normal platelet count without bleeding symptoms or any complications, although immunoglobulin or steroid was not used.