ABSTRACT
Most elective cesarean sections are conducted under spinal anesthesia. Regional anesthesia has become the preferred technique, because general anesthesia is associated with a greater risk of maternal morbidity and mortality. In patients without absolute contraindication, spinal anesthesia is avoided, when procedural difficulty is increased by severe spinal deformity. A 41-year-old female patient was 33 weeks into pregnancy. Her height and weight were 145 cm and 45 kg. The patient was planned for emergency cesarean section, due to cephalopelvic disproportion. Spinal anesthesia was planned since she was suffering from Duchenne's muscular dystrophy, and had risks of respiratory failure and prolonged mechanical ventilation after general anesthesia. However, the patient also had severe kyphoscoliosis, maybe due to Duchenne's muscular dystrophy. We are reporting a successful spinal anesthesia using real-time ultrasound guidance, for cesarean section in this obstetric patient with severe kyphoscoliosis.
Subject(s)
Adult , Female , Humans , Pregnancy , Anesthesia, Conduction , Anesthesia, General , Anesthesia, Spinal , Cephalopelvic Disproportion , Cesarean Section , Congenital Abnormalities , Emergencies , Mortality , Muscular Dystrophies , Respiration, Artificial , Respiratory Insufficiency , Scoliosis , UltrasonographyABSTRACT
BACKGROUND: Neuromuscular blocking agents (NMBAs) are a leading cause of perioperative anaphylaxis. However, the performance of systematic screening skin tests to detect reactions for NMBAs prior to general anesthesia is not recommended. We retrospectively examined intradermal tests (IDTs) for rocuronium and cisatracurium in patients with a history of allergy. METHODS: We reviewed the records of patients who underwent IDTs for NMBAs between January 1 and December 31, 2016. We analyzed the patients’ allergy histories and skin test results for NMBAs. RESULTS: The overall prevalence of positive IDTs was 5.8% (26/451), and there was no significant difference in prevalence among allergy types (P = 0.655). In logistic regression analysis, there was no allergy history that had a significant effect on positive IDT for NMBAs. CONCLUSIONS: We found no association between allergy history and positive skin test for NMBAs. Therefore, a systematic screening test for NMBAs or other anesthetic agents before anesthesia is not considered necessary even in patients with an allergy history.
Subject(s)
Humans , Anaphylaxis , Anesthesia , Anesthesia, General , Anesthetics , Hypersensitivity , Intradermal Tests , Logistic Models , Mass Screening , Neuromuscular Blocking Agents , Prevalence , Retrospective Studies , Skin Tests , SkinABSTRACT
Herpes zoster is an infectious disease of the dorsal root ganglion and sensory nerve fibers. Motor nerve involvement is a rare complication. Hiatal hernia occurs when the stomach protrudes into the thoracic cavity through the esophageal hiatus of the diaphragm. Herein, we present the case of a 78-year-old man with abdominal wall muscle paresis caused by herpes zoster, which resulted in a hiatal hernia.
Subject(s)
Aged , Humans , Abdominal Muscles , Abdominal Wall , Communicable Diseases , Diaphragm , Ganglia, Spinal , Hernia, Hiatal , Herpes Zoster , Nerve Fibers , Paresis , Stomach , Thoracic CavityABSTRACT
PURPOSE@#The purpose of this study was to evaluate the effectiveness of thoracic paravertebral block (TPVB) for management of pain during and after percutaneous radiofrequency ablation (RFA) of hepatic tumor.@*MATERIALS AND METHODS@#All patients were divided into non-TPVB (4 patients, 4 sessions of RFA for 4 tumors) and TPVB group (5 patients, 7 sessions of RFAs for 7 tumors). Ultrasound (US)-guided TPVB was performed at T7 level. The 15 mL of 0.375% ropivacaine was injected into right paravertebral space before RFA. If patients complained pain and asked analgesics or experienced pain with verbal numerical rating scale (VNRS) of more than 4, fentanyl 25 µg (up to 100 µg), pethidine 25 mg, and midazolam 0.05 mg/kg (up to 5 mg) were sequentially given intravenously during RFA.@*RESULTS@#Total intravenous morphine equivalence of analgesics before, during, and after RFA was 129.1 mg and 0.0 mg in non-TPVB and TPVB group, respectively.@*CONCLUSION@#US-guided TPVB may be an effective and safe anesthetic method for decreasing or eliminating pain during and after RFA for hepatic tumor and helpful in decreasing the usage of opioids.