ABSTRACT
BACKGROUND: During transurethral resection of bladder tumors (TURB) under spinal anesthesia, electrical resection of the lateral wall mass may cause violent adductor contraction and possible inadvertent bladder perforation. Therefore, obturator nerve block (ONB) is mandatory after spinal anesthesia to avoid adductor muscle contraction. We compared the success rate and efficacy of an inguinal approach, to a pubic approach for ONB. METHODS: One hundred and two patients who required ONB undergoing TURB with spinal anesthesia were included in this study. After spinal anesthesia, ONB was performed with an inguinal approach (Group I, n = 51) or pubic approach (Group P, n = 51) using a nerve stimulator. In the pubic approach, a needle was inserted at a point 1.5 cm lateral and 1.5 cm inferior to the pubic tubercle. For the inguinal approach, a needle was inserted at the midpoint of the femoral artery and the inner margin of the adductor longus muscle 0.5 cm below the inguinal crease. If the adductor contracture had not occurred by the 3rd attempt, it was defined as a failed block. Puncture frequency, success rate, anatomical characteristics, and the presence of adductor muscle contraction during operation were evaluated. RESULTS: The success rate of ONB was higher in group I compared to group P (96.1% vs. 84.0%, P = 0.046) and the frequency of needle attempts was lower in group I than in group P (1.8 +/- 0.9 vs. 1.3 +/- 0.6, P = 0.01). CONCLUSIONS: The inguinal approach for ONB appears to be technically easier and offers certain anatomical advantages when compared to the pubic approach.
Subject(s)
Humans , Anesthesia, Spinal , Contracts , Contracture , Femoral Artery , Muscle Contraction , Muscles , Needles , Obturator Nerve , Punctures , Urinary Bladder , Urinary Bladder NeoplasmsABSTRACT
Excess absorption of fluid distention media remains an unpredictable complication of operative hysteroscopy and may lead to lethal conditions. We report an extreme hyponatremia, caused by using an electrolyte-free 5 : 1 sorbitol/mannitol solution as distention/irrigation fluid for hysteroscopic myomectomy. A 34-year-old female developed severe pulmonary edema and extreme hyponatremia (83 mmol/L) during transcervical endoscopic myomectomy. A brain computed tomography showed mild brain swelling without pontine myelinolysis. The patient almost fully recovered in two days. Meticulous attention should be paid to intraoperative massive absorption of fluid distention media, even during a simple hysteroscopic procedure.
Subject(s)
Adult , Female , Humans , Absorption , Acidosis , Brain , Brain Edema , Hyponatremia , Hysteroscopy , Pulmonary EdemaABSTRACT
A tracheal intubation-related tracheobronchial rupture is a relatively rare complication. We report a case of tracheobronchial rupture after single lumen endotracheal intubation. Twenty four hours after extubation of an endotracheal tube, subcutaneous emphysema developed on the patient's neck. A pneumomediastinum was also detected by computerized tomography (CT). The patient recovered uneventfully after conservative management.