ABSTRACT
Pelvic visceral pain associated with both cancer and chronic benign conditions may be alleviated by superior hypogastric plexus block (SHPB). The complications of SHPB include infection, bleeding, or intravascular injection because of the adjacent location of the iliac vessel to the route of needle insertion, and pelvic visceral damage. However, acute ureteral obstruction leading to acute renal failure (ARF) as a complication of SHPB has not been reported to date in the literature. We report a patient with ARF that resulted from acute ureteral obstruction following SHPB performed for the relief of lower abdominal pain and tenesmus in metastatic ureter cancer.
Subject(s)
Humans , Abdominal Pain , Acute Kidney Injury , Hemorrhage , Hypogastric Plexus , Needles , Ureteral Neoplasms , Ureteral Obstruction , Visceral PainABSTRACT
BACKGROUND: The cuff of the laryngeal mask airway (LMA) is preferred to be partially inflated before insertion in pediatric cases. However, it is not known how much inflation is appropriate. In addition, intra-cuff pressure is not routinely monitored in many institutions despite the fact that a neglected high cuff pressure could cause several complications. This study was conducted to determine whether the cuff inflated with its resting volume before insertion could have a clinically tolerable intra-cuff pressure after insertion. METHODS: One hundred fifty unpremedicated children aged 0 to 9 yrs were enrolled. The pilot balloon valve was connected to a piston-free syringe to keep the valve open to the atmosphere and allowing the pressure within the cuff of to LMA to equalize to atmospheric pressure. Anesthesia was induced with 6 vol% of sevoflurane in oxygen. After insertion and final positioning of the LMA, the intra-cuff pressure was measured using a cuff pressure manometer. RESULTS: The mean intra-cuff pressure was 50 +/- 12.9 cmH2O; intra-cuff pressures were 39.1 +/- 9.3, 51.6 +/- 11.2, and 64.6 +/- 12.5 cmH2O for LMAs of sizes 1.5, 2, and 2.5, respectively. Intra-cuff pressure of more than 60 cmH2O was measured in 26 patients, and the median value was 70 cmH2O. There was weak statistical correlation among age, height, and weight with intra-cuff pressure. CONCLUSIONS: The cuff inflated by the resting volume before insertion may be a simple method for guaranteeing tolerable cuff pressure after insertion.
Subject(s)
Aged , Child , Humans , Anesthesia , Atmosphere , Atmospheric Pressure , Inflation, Economic , Laryngeal Masks , Methyl Ethers , Oxygen , SyringesABSTRACT
BACKGROUND: The cuff of the laryngeal mask airway (LMA) is preferred to be partially inflated before insertion in pediatric cases. However, it is not known how much inflation is appropriate. In addition, intra-cuff pressure is not routinely monitored in many institutions despite the fact that a neglected high cuff pressure could cause several complications. This study was conducted to determine whether the cuff inflated with its resting volume before insertion could have a clinically tolerable intra-cuff pressure after insertion. METHODS: One hundred fifty unpremedicated children aged 0 to 9 yrs were enrolled. The pilot balloon valve was connected to a piston-free syringe to keep the valve open to the atmosphere and allowing the pressure within the cuff of to LMA to equalize to atmospheric pressure. Anesthesia was induced with 6 vol% of sevoflurane in oxygen. After insertion and final positioning of the LMA, the intra-cuff pressure was measured using a cuff pressure manometer. RESULTS: The mean intra-cuff pressure was 50 +/- 12.9 cmH2O; intra-cuff pressures were 39.1 +/- 9.3, 51.6 +/- 11.2, and 64.6 +/- 12.5 cmH2O for LMAs of sizes 1.5, 2, and 2.5, respectively. Intra-cuff pressure of more than 60 cmH2O was measured in 26 patients, and the median value was 70 cmH2O. There was weak statistical correlation among age, height, and weight with intra-cuff pressure. CONCLUSIONS: The cuff inflated by the resting volume before insertion may be a simple method for guaranteeing tolerable cuff pressure after insertion.