ABSTRACT
A 61-year-old man who had cholangiocarcinoma with multiple metastasises was referred to our hospital for his pain control.Celiac plexus block with 99.9% alcohol was performed by the retrocrural approach under fluoroscopic guidance.Examination of the patient at fifteen minutes after successfully performing the diagnostic block showed no sensory or motor change.Forty-eight hours after the neurolysis, the patient's lower extremities were totally paralyzed, and he could not walk nor control his anal sphincter.But thereafter he progressively recovered.Five days after celiac plexus neurolysis, he was able to walk with support from one hand.Reversible ischemia of the spinal cord due to damage to the Adamkiewicz arterial blood supply was thought to be the cause.
Subject(s)
Humans , Middle Aged , Celiac Plexus , Cholangiocarcinoma , Ischemia , Lower Extremity , Neoplasm Metastasis , Paraplegia , Spinal CordABSTRACT
Endotracheal obstruction may cause serious complications, including cardiovascular instability, pneumothorax, pulmonary edema and even brain death. A 21-year-old man was scheduled to undergo an open reduction for an orbital fracture. The patient had tracheostomy with an 8.0 mm tracheostomy tube 3 weeks ago and was breathing well spontaneously. When the cuff of tracheostomy tube was inflated for assisted manual ventilation and the induction of anesthesia, signs of partial endotracheal obstruction were observed, including high airway pressure, low tidal volume and high ETCO2. Large dried mucous plug was impacted in the tracheostomy tube. After removing this plug with a sterile surgical forcep, effective ventilation was recovered without complications. The case like this nearly fatal obstruction by large dried mucous plug was rarely reported, but it should be considered cautiously when a patient uses tracheostomy tube as an airway before general anesthesia.
Subject(s)
Humans , Young Adult , Airway Obstruction , Anesthesia , Anesthesia, General , Brain Death , Orbital Fractures , Pneumothorax , Pulmonary Edema , Respiration , Surgical Instruments , Tidal Volume , Tracheostomy , VentilationABSTRACT
BACKGROUND: The issue of using phenylephrine in hemorrhagic shock treatment has been controversial because it is known that phenylephrine improves the tissue perfusion by increasing arterial blood pressure but deteriorates the myocardium by increasing afterload and decreasing myocardial oxygen delivery via coronary vasoconstriction. This study was aimed to assess the effects of phenylephrine on hemodynamic variables, cardiac performance, and myocardial oxygen balance in resuscitation from hemorrhagic shock. METHODS: Twenty anesthetized dogs were randomly divided into phenylephrine group and control group. After inducing hemorrhagic shock, resuscitation was done with phenylephrine and 0.9% normal saline respectively. We measured hemodynamic indices, blood gas parameter and cardiac enzymes which indicate myocardial demage. RESULTS: In both groups, cardiac output and hemodynamic indices improved. In phenylephrine group, the systemic oxygen delivery and consumption was much higher and the myocardial oxygen extraction ratio was maintained at the lower level than the control group. In addition, the CK-MB was higher at the early phase of resuscitation and the troponin T was also higher than the control group during the whole period of resuscitation. Creatine kinase-MB increased during early resuscitation in phenylephrine group but kept decreasing after that and there's no difference between two groups. Troponin T was higher in the phenylephrine group after resuscitation. CONCLUSIONS: We concluded that phenylephrine improves myocardial oxygen balance and contractility without serious myocardial demage during resuscitation from hemorrhagic shock.
Subject(s)
Animals , Dogs , Arterial Pressure , Cardiac Output , Creatine , Hemodynamics , Myocardium , Oxygen , Perfusion , Phenylephrine , Resuscitation , Shock, Hemorrhagic , Troponin T , VasoconstrictionABSTRACT
Recently fibrin glue, a hemostatic or adhesive material has been used worldwide in surgical procedures. There have been only limited numbers of reports on anaphylaxis following the topical use of fibrin glue. Here, we experienced an anaphylactoid reaction during transsphenoidal removal of pituitary tumor after local application of fibrin glue including aprotinin. Unexpected hypotension and erythematous eruptions on whole body developed suddenly after packing of it at operation field. Treatment with aggressive volume replacement with vasoactive agents and steroids were done immediately on the diagnosis of anaphylactoid reaction and patient recovered without any complications.