Spinal anesthesia and postoperative epidural analgesia in a patient with congenital central hypoventilation syndrome: a case report / 대한마취과학회지

BACKGROUND: Congenital central hypoventilation syndrome (CCHS) is a rare disorder characterized by alveolar hypoventilation and autonomic dysregulation. Patients with CCHS have adequate ventilation while awake but exhibit hypoventilation while asleep. More severely affected patients exhibit hypoventilation both when awake and when asleep. CASE: Here, we report a case of successful spinal anesthesia and postoperative epidural analgesia in a patient with CCHS who underwent orthostatic surgery. CONCLUSIONS: In patients with CCHS, anesthesia is used with the goal of minimizing respiratory depression to avoid prolonged mechanical ventilation. Regional anesthesia should be considered where appropriate. Continuous oxygen saturation and end-tidal carbon dioxide monitoring must be available.

Spinal anesthesia and postoperative epidural analgesia in a patient with congenital central hypoventilation syndrome: a case report / 대한마취과학회지

BACKGROUND@#Congenital central hypoventilation syndrome (CCHS) is a rare disorder characterized by alveolar hypoventilation and autonomic dysregulation. Patients with CCHS have adequate ventilation while awake but exhibit hypoventilation while asleep. More severely affected patients exhibit hypoventilation both when awake and when asleep.CASE: Here, we report a case of successful spinal anesthesia and postoperative epidural analgesia in a patient with CCHS who underwent orthostatic surgery.@*CONCLUSIONS@#In patients with CCHS, anesthesia is used with the goal of minimizing respiratory depression to avoid prolonged mechanical ventilation. Regional anesthesia should be considered where appropriate. Continuous oxygen saturation and end-tidal carbon dioxide monitoring must be available.

Awake fiberoptic orotracheal intubation using a modified Guedel airway in a patient with craniocervical instability and an anticipated difficult airway: A case report

In patients with upper cervical instability, airway management may provoke subluxation of the craniocervical region and neurologic injury, and can be challenging for the anesthesiologist. Endotracheal intubation using a fiberoptic bronchoscope is frequently used in these patients to minimize spine motion, but this procedure may fail in patients with altered airway anatomy. When fiberoptic endotracheal intubation fails in these patients, optional intubation methods are limited. We describe successful awake fiberoptic orotracheal intubation using a modified Guedel airway divided in the midline for a 59-year-old man with an anticipated difficult airway, due to limited mouth opening, a nasopharyngeal tumor, and craniocervical spine instability after failure of conventional fiberoptic orotracheal intubation.

The effects of epidural versus intravenous patient-controlled analgesia on postoperative outcomes in elderly patients who have undergone gastrectomy: a retrospective trial

BACKGROUND: Efforts for improving surgical outcomes in elderly patients should include the prevention of perioperative complications and proper postoperative pain management. Epidural analgesia is effective in decreasing perioperative stress and postoperative complications, and in improving recovery. Recently, it has been suggested that epidural analgesia may attenuate immune suppression during the perioperative period and lead to reductions in cancer recurrence and improvements in overall survival. Assuming that these effects of epidural analgesia are present in vulnerable elderly patients, we compared the efficacy of epidural patient-controlled analgesia and intravenous patientcontrolled analgesia on postoperative outcomes in elderly patients who had undergone gastrectomy. METHODS: We evaluated 214 elderly patients who had undergone elective open gastrectomy for gastric cancer from 2011 to 2014. The demographic characteristics, analgesic efficacy, complications within the first 30 postoperative days, hospital stay, 24-month postoperative morbidity, cancer recurrence, and mortality were studied retrospectively. RESULTS: Two-hundred and five patients were analyzed. Eighty-five patients received epidural patient-controlled analgesia (EPCA group) and 120 patients received intravenous patient- controlled analgesia (IVPCA group). The maximum pain scores were decreased to a greater extent in the EPCA group on the day of the operation (P < 0.001) and on the first postoperative day (P = 0.001) when compared to the IVPCA group. The patients in the EPCA group also required less analgesics on the day of the operation (P = 0.033) than those in the IVPCA group. The effect of EPCA on complications within the first 30 postoperative days, 24-month postoperative morbidity, cancer recurrence, and mortality were negligible in our study. CONCLUSIONS: EPCA provided more effective pain control than IVPCA in elderly patients who had undergone elective gastric cancer surgery, but did not affect postoperative outcomes.

The effects of epidural versus intravenous patient-controlled analgesia on postoperative outcomes in elderly patients who have undergone gastrectomy: a retrospective trial

BACKGROUND: Efforts for improving surgical outcomes in elderly patients should include the prevention of perioperative complications and proper postoperative pain management. Epidural analgesia is effective in decreasing perioperative stress and postoperative complications, and in improving recovery. Recently, it has been suggested that epidural analgesia may attenuate immune suppression during the perioperative period and lead to reductions in cancer recurrence and improvements in overall survival. Assuming that these effects of epidural analgesia are present in vulnerable elderly patients, we compared the efficacy of epidural patient-controlled analgesia and intravenous patientcontrolled analgesia on postoperative outcomes in elderly patients who had undergone gastrectomy. METHODS: We evaluated 214 elderly patients who had undergone elective open gastrectomy for gastric cancer from 2011 to 2014. The demographic characteristics, analgesic efficacy, complications within the first 30 postoperative days, hospital stay, 24-month postoperative morbidity, cancer recurrence, and mortality were studied retrospectively. RESULTS: Two-hundred and five patients were analyzed. Eighty-five patients received epidural patient-controlled analgesia (EPCA group) and 120 patients received intravenous patient- controlled analgesia (IVPCA group). The maximum pain scores were decreased to a greater extent in the EPCA group on the day of the operation (P < 0.001) and on the first postoperative day (P = 0.001) when compared to the IVPCA group. The patients in the EPCA group also required less analgesics on the day of the operation (P = 0.033) than those in the IVPCA group. The effect of EPCA on complications within the first 30 postoperative days, 24-month postoperative morbidity, cancer recurrence, and mortality were negligible in our study. CONCLUSIONS: EPCA provided more effective pain control than IVPCA in elderly patients who had undergone elective gastric cancer surgery, but did not affect postoperative outcomes.