Dilema diagnóstico en un paciente despierto con edema pulmonar tras craneotomía: reporte de caso / A diagnostic dilemma in an alert patient with pulmonary oedema following craniotomy: A case report

Introduction: We present a case developing idiopathic pulmonary oedema following craniotomy without any neurological symptoms. Case description: A 70-year-old female, who had unremarkable medical history, underwent removal of brain tumour under general anaesthesia. Craniotomy was uneventfully performed and her respiratory and haemodynamic conditions during the operation were normal. Immediately after the operation, she regained consciousness and was neurologically intact. However, her oxygenation was not sufficient without oxygen administration, her chest X-ray showed pulmonary oedema. Gradually, her pulmonary oedema in the chest X-rays disappeared. There was no specific reason of pulmonary oedema except for intracranial manipulation, therefore, it was considered as neurologic pulmonary oedema. Conclusion: In this case, we merely might have followed the restoration process from neurologic pulmonary oedema developing during the operation.

Introducción: Presentamos un caso de desarrollo de edema pulmonar idiopático tras craneotomía sin síntomas neurológicos. Descripción del aso: Una paciente de sexo femenino de 70 años de edad con una historia médica sin interés se sometió a una extirpación de tumor cerebral bajo anestesia general. La craneotomía se realizó sin eventos notables y sus condiciones respiratorias y hemodinámicas durante la operación se mantuvieron normales. Inmediatamente al concluir la operación la paciente recobró su conciencia y se encontró en estado neurológico intacto. Sin embargo, su oxigenación no era suficiente sin administración de oxígeno, y las radiografías indicaban edema pulmonar. Gradualmente su edema pulmonar visualizado en las radiografías torácicas desapareció. No había ninguna razón para el edema pulmonar excepto manipulación intracraneal, así que fue considerado como un edema pulmonar neurológico. Conclusión: En este caso, habríamos simplemente seguido el proceso de restauración del edema pulmonar neurológico que se desarrolló durante la operación.

Low-dose ropivacaine for supraclavicular brachial plexus block combined with general anesthesia for successful postoperative analgesia: a case series

Ropivacaine, a long-acting local anesthetic agent, has been used for postoperative analgesia in brachial plexus block [BPB] at high doses. However, use of lower doses would reduce the occurrence of adverse effects. We applied BPB with low-dose ropivacaine [10 mL of 0.375% ropivacaine] after induction of general anesthesia for surgery of the upper extremities in 62 patients at our hospital. Ropivacaine was administered via a fluoroscopy-guided supraclavicular method. Analgesic effects during surgery, visual analog scale pain scores, skin sensation, muscle strength, and postoperative patient satisfaction indices were evaluated. Fifty-six patients [90.3%] did not require supplemental analgesics during surgery. The remaining six patients were administered fentanyl due to the insufficient analgesic effects of the nerve block. Some adverse effects, including numbness and delayed motor and sensory recovery of the upper extremities, were observed. The mean postoperative patient-evaluated visual satisfaction scale was 94.1. Our results suggest that low-dose ropivacaine is clinically acceptable for BPB under general anesthesia

Difficult passage of the endotracheal tube and massive nasal bleeding during awake nasal fiberoptic intubation in a patient with airway obstruction caused by neck hematoma-a case report

A 60 yr-old male underwent anterior cervical fusion under general anesthesia. Neck swelling was observed at the next morning. Subsequently, emergent CT scanning was performed, which revealed a retropharyngeal hematoma narrowing the upper airway and right anterior neck hematoma significantly deviating the trachea and larynx. Nasal intubation was attempted but difficult passage of the endotracheal tube counteracted this procedure. Immediately, massive nasal bleeding occurred, which worsened the situation. Subsequently, oral fiberoptic intubation with the aid of McCoy type laryngoscope was tried and intubation was barely established. The patient was submitted to emergent evacuation of the hematoma. Reevaluation of the preoperative CT images showed the nasal cavity narrowing because of widespread nasal mucosal swelling. It is necessary to anticipate that nasal mucosal swelling and bleeding tendency due to impairment of venous drainage can exist in such a case