ABSTRACT
The mortality scoring systems for patients with end-stage liver disease have evolved from the Child-Turcotte-Pugh score to the model for end-stage liver disease (MELD) score, affecting the wait list for liver allocation. There are inherent weaknesses in the MELD score, with the gradual decline in its accuracy owing to changes in patient demographics or treatment options. Continuous refinement of the MELD score is in progress; however, both advantages and disadvantages exist. Recently, attempts have been made to introduce artificial intelligence into mortality prediction; however, many challenges must still be overcome. More research is needed to improve the accuracy of mortality prediction in liver transplant recipients.
ABSTRACT
Mucopolysaccharidoses are rare lysosomal storage diseases resulting from defects in lysosomal enzymes involved in degradation of glycosaminoglycans. Different mucopolysaccharidoses are caused by different enzyme deficiencies The anesthetic complications are related to the organs involved. Patients with mucopolysaccharidoses are rare, and few anesthetists encounter such patients. We experienced a case of mucopolysaccharidoses type II. Several endotracheal intubation attempts were tried, but we experienced failed endotracheal intubation. And we decided to proceed with surgery under bag-mask ventilation because of the short operation time. There’s no desaturation time. And the patient’s spontaneous ventilation was recovered and awakened. We have also briefly discussed the pathophysiology, clinical features, and possible airway management options for patients with mucopolysaccharidoses type II.
ABSTRACT
Magnetic resonance imaging (MRI) is a useful and safe imaging modality for examining preterm infants. However, MRI examination requires careful precautions, and infants and children are likely to require deep sedation or anesthesia to keep them still during the examination. Sedation has various risks and the greatest concern of sedation is cardiorespiratory events. In addition, delicate titration is also necessary for preterm infants because propofol pharmacokinetics is different from those in older children. We successfully completed sedation of a preterm neonate (gestational age, 32+1 weeks; birth weight, 1,970 g) with a history of frequent apnea through careful assessment and continuous monitoring. We want to suggest alternative options for airway management of the high risk of respiratory complications.
ABSTRACT
General anesthesia is associated with a risk for postoperative pulmonary complications. The risk is even higher in patients with chronic respiratory failure, and postoperative mortality rates are high. Proper perioperative anesthetic management is important in such patients. Therefore, it is essential to optimize the patient’s physical status before anesthesia and to determine the optimal anesthesia technique based on the pre-anesthesia evaluation of the patient’s pulmonary function. We successfully performed abdominal surgery under spinal anesthesia in a patient with severe chronic respiratory failure.
ABSTRACT
Nasotracheal intubation is valuable during intra-oral surgery. A common complication of this technique is epistaxis. We experienced a case of middle turbinate fracture which showed no immediate signs of fracture such as bleeding or avulsed particles. Two months later, it was discovered in the form of nasal obstruction with a mass-like lesion. Symptoms associated with traumatic intubation usually develop during surgery, and it is rare to be found a long time after surgery. We will review the anatomical and technical aspects for safe nasotracheal intubation.
ABSTRACT
Antimicrobial filters that prevent cross-contamination through anesthesia equipment are commonly used in operating rooms. Occlusion of this filter leads to the patient’s airway obstruction, which may lead to fatal outcomes. We report a case of the airway obstruction by antimicrobial filter occlusion during general anesthesia, and symptoms recovered immediately after removal of the filter.
ABSTRACT
Background@#Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is used to improve oxygenation, with the added benefit of a smaller increase in CO2 if self-respiration is maintained with THRIVE. Despite these advantages, the use of THRIVE through a nasal cannula is limited in situations such as epistaxis or a basal skull fracture. CaseWe successful used THRIVE, through the oral route under general anesthesia with spontaneous breathing in a morbidly obese patient (weight, 148 kg; height, 183 cm; body mass index, 44.2 kg/m2) who received transnasal steroid injections due to subglottic stenosis. @*Conclusions@#THRIVE through the oral route may be an effective novel option, although further studies are needed.
ABSTRACT
Monitoring cerebral oxygenation using a near infrared spectroscopy (NIRS) device is useful for estimating cerebral hypoperfusion and is available during liver transplantation (LT). However, high serum bilirubin concentration can interfere with NIRS because bilirubin absorbs near infrared light. We report a patient who underwent LT with a diagnosis of vanishing bile duct syndrome, whose regional cerebral oxygen saturation (rSO₂) remained below 15% even with alert mental status and SpO2₂ value of 99%. The rSO₂ values were almost fixed at the lowest measurable level throughout the intra- and postoperative period. We report a case of erroneously low rSO₂ values during the perioperative period in a liver transplant recipient which might be attributable to skin pigmentation rather than higher serum bilirubin concentration.
Subject(s)
Humans , Bile Ducts , Bile , Bilirubin , Diagnosis , Hyperbilirubinemia , Hypoxia, Brain , Liver Transplantation , Liver , Oxygen , Perioperative Period , Postoperative Period , Skin Pigmentation , Spectrum Analysis , Transplant RecipientsABSTRACT
Posterior glottic stenosis (PGS) is frequently caused by prolonged intubation complications, which may limit the movement of the vocal cords and obstruct airway obstruction. Despite of a life-threatening condition, it might be overlooked in asymptomatic individual. A 63-year-old female was scheduled for arthroscopic rotator cuff repair. The patient had experienced 2 times of intubation and organophosphate poisoning for suicide. Both of 7.0- and 6.5-mm inner diameter endotracheal tubes could not be passed vocal cords. After two failed attempts at intubation, adhesion of posterior part of vocal cord was revealed. We stopped the tracheal intubation and called the otolaryngologist, and adhesiolysis was performed under direct laryngosope. Thereafter, endotracheal intubation was performed successfully with 6.5-mm endotracheal tube.
Subject(s)
Female , Humans , Middle Aged , Airway Management , Airway Obstruction , Constriction, Pathologic , Intubation , Intubation, Intratracheal , Organophosphate Poisoning , Rotator Cuff , Suicide , Vocal CordsABSTRACT
One-lung ventilation is an anesthesiological technique to accomplish surgical visualization during thoracic surgical procedures, and is often required unexpectedly during surgery. Traditionally the double lumen tube is considered the gold standard for lung separation. Despite being equally feasible for standard situations, there are special populations and circumstances requiring the use of a bronchial blocker to establish one-lung ventilation. We have experienced unexpected change to one-lung ventilation with bronchial blocker. A 40-year-old (158 cm, 48 kg) woman was scheduled for emergency exploratory laparotomy due to panperitonitis. A sudden diaphragmatic perforation occurred during the operation. Since oxygen saturation was reduced, intraoperative tube change was not available. Therefore, one-lung ventilation was done with bronchial blockers. After the bronchial blocker was placed, one-lung ventilation was well maintained and the operation was terminated successfully.
Subject(s)
Adult , Female , Humans , Emergencies , Laparotomy , Lung , One-Lung Ventilation , Oximetry , Oxygen , Thoracic Surgical Procedures , ThoracoscopyABSTRACT
Epinephrine is used with lidocaine to provide bloodless surgical field and to prolong the action of local anesthetics. But epinephrine also has many adverse reactions, such as agitation, restlessness, headache, tachycardia, hypertension, and some significantly more dangerous conditions including myocardial ischemia, ventricular arrhythmia, cerebral hemorrhage and pulmonary edema, cardiac arrest, etc. We have experienced epinephrine-induced acute pulmonary edema due to submucosal intranasal application of epinephrine soaked gauze during septoplasty. The patient was successfully treated in intensive care unit with positive pressure ventilation, diuretics, and inotropic support. He was extubated after 5 hours and discharged after 7 days without any complications.
Subject(s)
Humans , Anesthetics, Local , Arrhythmias, Cardiac , Cerebral Hemorrhage , Dihydroergotamine , Diuretics , Epinephrine , Headache , Heart Arrest , Hypertension , Intensive Care Units , Lidocaine , Myocardial Ischemia , Positive-Pressure Respiration , Psychomotor Agitation , Pulmonary Edema , TachycardiaABSTRACT
Hypoglossal nerve palsy is a rare complication of endotracheal intubation. The mechanism of nerve palsy is mainly attributed to stretching or compression of the nerve during airway manipulation. The cuff pressure can also contribute to the occurrence of hypoglossal nerve palsy. Since it is often accompanied by other cranial nerve palsies, meticulous overall cranial nerve examination is necessary. The main treatment is supportive with respiratory monitoring. The prognosis is favorable. Majority of patients achieve nearly full recovery of nerve function. Here, we report a case of unilateral hypoglossal nerve palsy following usual, uneventful endotracheal intubation and review the literature.
Subject(s)
Humans , Anesthesia , Cranial Nerve Diseases , Cranial Nerves , Hypoglossal Nerve Diseases , Hypoglossal Nerve , Intraoperative Complications , Intubation , Intubation, Intratracheal , Paralysis , PrognosisABSTRACT
BACKGROUND: The differences between neuromuscular blocking (NMB) drugs on the efficacy of intraoperative motor-evoked potential (MEP) monitoring have not been established through clinical study. We compared the effects of vecuronium and cisatracurium on the efficacy of intraoperative MEP monitoring. METHODS: We enrolled 72 patients who had undergone neurosurgery with MEP monitoring. We randomly allocated the subjects into one of two groups, in whom we maintained continuous intravenous vecuronium (Group V) or cisatracurium (Group C) infusion during the surgeries; the target partial NMB for maintenance was T1/Tc 50% (T1, first twitch of TOF response; Tc, control response of T1 before NMB drug injection). We compared the means and coefficients of variation (CV, %) of all measured MEP amplitudes and the frequencies of NMB drug dose changes. RESULTS: The means and CVs of MEP amplitude and latency in all four limbs did not differ significantly between the groups, although we did change the continuous NMB drug doses in group V significantly less often than in group C. CONCLUSIONS: There were no significant differences between vecuronium and cisatracurium on the MEP variability and mean amplitudes. However, cisatracurium needed more frequent dose changes to maintain T1/Tc 50%.
Subject(s)
Humans , Clinical Study , Extremities , Intraoperative Neurophysiological Monitoring , Neuromuscular Blockade , Neurosurgery , Vecuronium BromideABSTRACT
No abstract available.
Subject(s)
Female , Pregnancy , Analgesia , Bradycardia , Labor PainABSTRACT
No abstract available.
Subject(s)
Female , Pregnancy , Analgesia , Bradycardia , Labor PainABSTRACT
Two cases were reported in which severe postoperative laryngeal edema were developed after the operation of diffuse idiopathic skeletal hyperostosis (DISH) of cervical spine. In the first case, sudden airway obstruction was developed in the general ward 6 hour after uneventful decompression surgery for osteophyte. In the second patient, an elective preoperative tracheostomy was performed before surgery but the tube could not be removed for 2 months because of laryngeal edema and decreased vocal cord mobility. It should be emphasized that this airway problem can develop during the postoperative as well as the preoperative period, especially in the case of anterior cervical spine surgery.