ABSTRACT
Aspiration pneumonia rarely occurs during general anesthesia; however, it can result in fatal pulmonary complications. To reduce aspiration pneumonia, a preoperative fasting time of 8 hours is recommended. A 4-year-old boy with ankyloglossia was scheduled for frenotomy. He completed preoperative fasting time and had no digestive symptoms. Pulmonary aspiration due to unexpected massive vomiting occurred during anesthesia induction. The patient's airway was immediately secured by endotracheal tube. The vomitus in the airway tract was removed by fiberoptic bronchoscopy. Abdomen radiograph taken after this event showed paralytic ileus which can cause aspiration of gastric contents. We describe a case of pneumonia caused by aspiration of gastric contents in a pediatric patient who followed fasting instructions and who was scheduled for outpatient surgery.
Subject(s)
Child, Preschool , Humans , Male , Abdomen , Ambulatory Surgical Procedures , Anesthesia , Anesthesia, General , Bronchoscopy , Fasting , Intestinal Pseudo-Obstruction , Pneumonia , Pneumonia, Aspiration , VomitingABSTRACT
BACKGROUND: The aim of this study was to determine whether the end-tidal concentration of desflurane would be affected by a breathing circuit system filter attached at two different positions in anesthetic breathing circuit systems. METHODS: An artificial lung was ventilated under five different conditions. The first group was without any filter or desflurane (n = 5, sham), the second was with desflurane but without any filter (n = 10, control), the third group had a bacterial filter on the expiratory limb (n = 10), and the fourth and fifth groups had a viral/bacterial filter added on the expiratory limb (n = 10) or at the Y-piece of the breathing circuit (n = 10), respectively. In all groups except the sham, administration of 10% desflurane was performed for 5 minutes and then stopped for 5 minutes. RESULTS: The mean (SD) end-tidal concentration of desflurane for the groups described above peaked at 0 (0), 9.8 (0.1), 9.8 (0.1), 8.5 (0.1), and 6.7% (0.1) (P < 0.001), respectively. There was no difference in the desflurane concentrations and the expired tidal volume over time between the control and bacterial group, but there was a significant difference between the control and the fourth and fifth groups (P < 0.001). CONCLUSIONS: Filters can affect the expiratory desflurane concentration during anesthesia.
Subject(s)
Anesthesia , Extremities , Lung , Respiration , Tidal VolumeABSTRACT
Aspiration pneumonia rarely occurs during general anesthesia; however, it can result in fatal pulmonary complications. To reduce aspiration pneumonia, a preoperative fasting time of 8 hours is recommended. A 4-year-old boy with ankyloglossia was scheduled for frenotomy. He completed preoperative fasting time and had no digestive symptoms. Pulmonary aspiration due to unexpected massive vomiting occurred during anesthesia induction. The patient's airway was immediately secured by endotracheal tube. The vomitus in the airway tract was removed by fiberoptic bronchoscopy. Abdomen radiograph taken after this event showed paralytic ileus which can cause aspiration of gastric contents. We describe a case of pneumonia caused by aspiration of gastric contents in a pediatric patient who followed fasting instructions and who was scheduled for outpatient surgery.
Subject(s)
Child, Preschool , Humans , Male , Abdomen , Ambulatory Surgical Procedures , Anesthesia , Anesthesia, General , Bronchoscopy , Fasting , Intestinal Pseudo-Obstruction , Pneumonia , Pneumonia, Aspiration , VomitingABSTRACT
No abstract available.
ABSTRACT
PURPOSE: The purpose of this study was to investigate the effectiveness and safety of monitored anesthesia care (MAC) using dexmedetomidine for its sedative and analgesic effect during varicose vein surgery. METHODS: Forty-two patients, who underwent varicose vein surgery, were divided into the MAC group (n = 20) or the spinal anesthesia group (n = 22) for randomized clinical trial. In the MAC group, dexmedetomidine was administered by a loading dose of 1 microg/kg for 10 minutes, followed by a maintenance infusion of 0.2-1.0 microg/kg/hr. Ketamine was used for intermittent injection. In the spinal anesthesia group, midazolam was used for sedation. Intraoperative vital signs, the number of adverse events, and the satisfaction of patients and surgeons concerning the anesthetic condition were compared between the two groups. RESULTS: Systolic blood pressure was intraoperatively significantly different over time between the two groups. The groups had statistical differences in the change in heart rate with regard to time. In the postanesthetic care unit, patients and surgeons in the MAC group had a lower satisfaction score, compared to patients and surgeons in the spinal anesthesia group. However, in the recovery period, patients had a positive perception concerning MAC anesthesia. In addition, without significant adverse events, the MAC group had a shorter time to possible ambulation, which indicated an early recovery. CONCLUSION: We believe that MAC using dexmedetomidine in combination with ketamine may be an alternative anesthetic technique for varicose vein surgery with regard to a patient's preference and medical condition.
Subject(s)
Humans , Anesthesia , Anesthesia, Spinal , Blood Pressure , Dexmedetomidine , Heart Rate , Ketamine , Midazolam , Varicose Veins , Vital Signs , WalkingABSTRACT
A 28-year-old male patient with right maxillar, zygomatic arch, orbital wall, and nasal bone fractures had an orthognathic and nasal surgery. Naso-endotracheal intubation is the first choice during surgical correction of dentofacial deformities in an orthognathic surgery; however, its presence can interfere with concomitant surgical procedures on the nose. Traditionally, the naso-endotracheal tube will be removed and replaced with an oro-endotracheal tube. We changed the endotracheal tube from nasal to oral by using an airway exchange catheter.
Subject(s)
Adult , Humans , Male , Catheters , Dentofacial Deformities , Intubation , Nasal Bone , Nasal Surgical Procedures , Nose , Orbit , Orthognathic Surgery , ZygomaABSTRACT
A 28-year-old male patient with occipito-atlanto-axial instability underwent a cervical fusion with posterior technique. Post-operatively, the endotracheal tube (ETT) was removed, and the patient was transferred to the intensive care unit. After transfer, an upper airway obstruction developed and reintubations with a laryngoscope were attempted but failed. We inserted a #4 proseal laryngeal mask airway (LMA) and passed a 5.0 mm ETT through the LMA with the aid of a fiberoptic bronchoscope. We passed a tube exchanger through the 5.0 mm ETT and exchanged it with a 7.5 mm ETT. This method may be a useful alternative for difficult tracheal intubations.
Subject(s)
Adult , Female , Humans , Male , Airway Obstruction , Bronchoscopes , Cervical Vertebrae , Intensive Care Units , Intubation , Laryngeal Masks , Laryngoscopes , Spinal FusionABSTRACT
Huntington's chorea is a rare hereditary disorder of the nervous system. It is inherited as an autosomal dominant disorder and is characterized by progressive chorea, dementia and psychiatric disturbances. The best anesthetic technique is yet to be established for these patients with increased risk of aspiration due to involvement of pharyngeal muscles and an exaggerated response to sodium thiopental and succinylcholine. The primary goal in general anesthesia for these patients is to provide airway protection and a rapid and safe recovery. We report the anesthetic management of a 51-year-old patient with Huntington's chorea admitted for an emergency operation.
Subject(s)
Humans , Anesthesia, General , Bronchoscopes , Chorea , Dementia , Emergencies , Huntington Disease , Intubation , Nervous System , Pharyngeal Muscles , Sodium , Succinylcholine , ThiopentalABSTRACT
No abstract available.
Subject(s)
Humans , Airway Management , Ankylosis , Mouth , Spondylitis, Ankylosing , Temporomandibular JointABSTRACT
OBJECTIVE: Transient anterograde amnesia is occasionally observed in a number of conditions, including migraine, focal ischemia, venous flow abnormalities, and after general anesthesia. The inhalation anesthetic, isoflurane, is known to induce transient anterograde amnesia. We examined the involvement of brain-derived neurotrophic factor (BDNF) and its receptor tyrosine kinase B (TrkB) in the underlying mechanisms of the isoflurane-induced transient anterograde amnesia. METHODS: Adult male Sprague-Dawley rats were divided into three groups : the control group, the 10 minutes after recovery from isoflurane anesthesia group, and the 2 hours after recovery from isoflurane anesthesia group (n=8 in each group). The rats in the isoflurane-exposed groups were anesthetized with 1.2% isoflurane in 75% nitrous oxide and 25% oxygen for 2 hours in a Plexiglas anesthetizing chamber. Short-term memory was determined using the step-down avoidance task. BDNF and TrkB expressions in the hippocampus were evaluated by immunofluorescence staining and western blot analysis. RESULTS: Latency in the step-down avoidance task was decreased 10 minutes after recovery from isoflurane anesthesia, whereas it recovered to the control level 2 hours after isoflurane anesthesia. The expressions of BDNF and TrkB in the hippocampus were decreased immediately after isoflurane anesthesia but were increased 2 hours after isoflurane anesthesia. CONCLUSION: In this study, isoflurane anesthesia induced transient anterograde amnesia, and the expressions of BDNF and TrkB in the hippocampus might be involved in the underlying mechanisms of this transient anterograde amnesia.