ABSTRACT
PURPOSE: Concomitant splenectomy in cirrhotic patients is known to ameliorate the tendency to bleed and it decreases the portal venous pressure (PVP). However, the direct measurement of the change in the PVP after concomitant splenectomy has not yet been reported. We tried to measure the change of the PVP before and after splenectomy. METHODS: From March 2000 to May 2006, 18 patients underwent anatomical liver resection with concomitant splenectomy. All the patients had liver cirrhosis, thrombocytopenia and/or esophageal varix. Through the 5 French feeding tube, which was inserted into the right gastroepiploic vein after laparotomy, we directly measured the PVP before and after splenectomy, and also under portal triad clamping (PTC). RESULTS: After splenectomy, the PVP decreased significantly from 261.11+/-45.87 mmH2O to 221.11+/-38.48 mmH2O (p<0.05). Under PTC, the PVP decreased significantly from 605.00+/-116.48 mmH2O to 513.89+/-70.56 mmH2O (p<0.05). CONCLUSION: Concomitant splenectomy in patients with liver cirrhosis resulted in a significant reduction of the PVP.
Subject(s)
Humans , Constriction , Esophageal and Gastric Varices , Factor IX , Laparotomy , Liver , Liver Cirrhosis , Portal Pressure , Splenectomy , Thrombocytopenia , VeinsABSTRACT
Anesthesiologists are occasionally faced with a dilemma in managing Jehovah's witness patients who refuse transfusion of blood or blood products in life threatening situations. We report a case in which a 28-year old Jehovah's witness parturient underwent an emergency cesarean section due to complex problems of fetal distress, twin pregnancy and preeclampsia. Despite the severe anemia, she had a good postoperative recovery without any complications. We suggest that it is necessary to know the religious background, ethical issues and conflicts in caring for Jehovah's Witness patients, and be familliar with perioperative management without transfusion for these cases.
Subject(s)
Adult , Female , Humans , Pregnancy , Anemia , Cesarean Section , Emergencies , Ethics , Fetal Distress , Pre-Eclampsia , Pregnancy, TwinABSTRACT
Postoperative hypertension occurs often in hypertensive patients due to pain, hypercapnia, hypoxemia, or excessive intravascular fluid volume. In addition, tracheal extubation exacerbates hypertension and tachycardia, which leads to left ventricular failure, myocardial infarction, or cerebral hemorrhage. We experienced a case of recurrent intracerebral hemorrhage after extubation in the postanesthetic care unit. The patient was 50-year old female who underwent total abdominal hysterectomy. Three months ago, she suffered a hypertensive cerebral hemorrhage with conservative treatment. Anesthesia induction and intraoperative course were relatively uneventful. In the postanesthetic care unit, she had voluntary movement of all limbs to command and fully awake consciousness. Immediately after tracheal extubation, the blood pressure was increased sharply to 200/110 mmHg. After then, the patient's mental status was deteriorated and the motor weakness of left extremities was developed. Brain CT showed a hypertensive hemorrhage at the right putamen and emergency stereotaxic aspiration was performed. After rehabilitative treatment, the patient was discharged with alert mental status and moderate improvement of motor weakness.
Subject(s)
Female , Humans , Middle Aged , Airway Extubation , Anesthesia , Hypoxia , Blood Pressure , Brain , Cerebral Hemorrhage , Consciousness , Emergencies , Extremities , Hemorrhage , Hypercapnia , Hypertension , Hysterectomy , Intracranial Hemorrhage, Hypertensive , Myocardial Infarction , Putamen , TachycardiaABSTRACT
Mediastinal masses may cause life-threatening complications such as major airways obstruction, superior vena caval obstruction, and cardiac compression during general anesthesia. We present a case in which superior vena caval and airway obstruction developed at induction of anesthesia in a patient with an anterior mediastinal mass. Shortly after induction of anesthesia in the supine position, the patient became difficult to ventilate and blood began to flow upward into the IV line. The patient was immediately turned to the right lateral position and allowed to breathe spontaneously. The ventilation of patient was improved significantly and cyanosis of the face and upper extremities disappeared. We think that general anesthesia should be avoided if at all possible in patients with mediastinal mass and alternative methods of diagnosis and management are discussed.