RESUMEN
Meralgia paresthetica is a rarely encountered sensory mononeuropathy characterized by paresthesia, pain or sensory impairment along the distribution of the lateral femoral cutaneous nerve (LFCN) caused by entrapment or compression of the nerve as it crossed the anterior superior iliac spine and runs beneath the inguinal ligament. There is great variability regarding the area where the nerve pierces the inguinal ligament, which makes it difficult to perform blind anesthetic blocks. Ultrasound has developed into a powerful tool for the visualization of peripheral nerves including very small nerves such as accessory and sural nerves. The LFCN can be located successfully, and local anesthetic solution distribution around the nerve can be observed with ultrasound guidance. Our successfully performed ultrasound-guided blockade of the LFCN in meralgia paresthetica suggests that this technique is a safe way to increase the success rate.
Asunto(s)
Ligamentos , Mononeuropatías , Bloqueo Nervioso , Síndromes de Compresión Nerviosa , Compuestos Orgánicos , Parestesia , Nervios Periféricos , Columna Vertebral , Nervio SuralRESUMEN
Tracheomegaly or tracheobronchomegaly is a rare syndrome that consists of marked dilatation of the trachea and the major bronchi, and this is usually due to a congenital defect of the elastic and muscle fibers of the tracheobroncheal tree. Physicians have had only limited experience with performing anesthesia in patients with this type of syndrome. This syndorme is diagnosed by roentenological investigation and this condition is frequently associated with chronic respiratory infection and partial airway obstruction. In this report, we present a case of performing tracheostomy for a patient with tracheomegaly, and this was probably secondary to mechanical ventilator therapy. The regular tracheostomy tube did not provided sufficient length to allow the cuff to lie properly in the trachea in this patient. Because of the peri-cuff air leakgae and hypercapnea after tracheostomy, we needed a longer tracheostomy tube. But we didn't have such a tube and we didn't know any other method, so we couldn't perform tracheostomy. Therefore, we introduced a method of reducing the length of the endotracheal tube to a suitable size until a longer tracheostomy tube can be obtained for those patients having tracheomegaly.
Asunto(s)
Humanos , Obstrucción de las Vías Aéreas , Anestesia , Bronquios , Anomalías Congénitas , Dilatación , Músculos , Tráquea , Traqueobroncomegalia , Traqueostomía , Ventiladores MecánicosRESUMEN
Tracheomegaly or tracheobronchomegaly is a rare syndrome that consists of marked dilatation of the trachea and the major bronchi, and this is usually due to a congenital defect of the elastic and muscle fibers of the tracheobroncheal tree. Physicians have had only limited experience with performing anesthesia in patients with this type of syndrome. This syndorme is diagnosed by roentenological investigation and this condition is frequently associated with chronic respiratory infection and partial airway obstruction. In this report, we present a case of performing tracheostomy for a patient with tracheomegaly, and this was probably secondary to mechanical ventilator therapy. The regular tracheostomy tube did not provided sufficient length to allow the cuff to lie properly in the trachea in this patient. Because of the peri-cuff air leakgae and hypercapnea after tracheostomy, we needed a longer tracheostomy tube. But we didn't have such a tube and we didn't know any other method, so we couldn't perform tracheostomy. Therefore, we introduced a method of reducing the length of the endotracheal tube to a suitable size until a longer tracheostomy tube can be obtained for those patients having tracheomegaly.
Asunto(s)
Humanos , Obstrucción de las Vías Aéreas , Anestesia , Bronquios , Anomalías Congénitas , Dilatación , Músculos , Tráquea , Traqueobroncomegalia , Traqueostomía , Ventiladores MecánicosRESUMEN
Here, we report a case of an occluded modified Tuohy needle (Espocan(R), B. Brown, Germany) due to the patient's own tissue. A 70-year-old female with left knee osteoarthritis was admitted for a total knee replacement arthroplasty under combined spinal-epidural anesthesia. Insertion of the Tuohy needle proceeded from the skin to 6 cm and then 6.5 cm, but there was no loss of resistance. We removed the needle from the patient and discovered a fibrous, white tissue inside the needle. We tried again and did the spinal-epidural anesthesia in another interspinous space. This time, we could feel the loss of resistance at 4 cm, but permanent leakage of clear fluid was seen in the epidural catheter so we removed the catheter. We observed the patient closely in the recovery room and ward, and no further complications were found. We present this case to remind the operator the importance of checking the epidural needle that possible may be occluded by a foreign body.
Asunto(s)
Anciano , Femenino , Humanos , Anestesia , Artroplastia , Artroplastia de Reemplazo de Rodilla , Catéteres , Cuerpos Extraños , Agujas , Osteoartritis de la Rodilla , Punciones , Sala de Recuperación , PielRESUMEN
BACKGROUND: Conservative management for the trigger fingers includes splinting, steroid injection and other adjuvant methods. If conservative treatment fails, a surgical release of the A1 pulley is offered. Although the success rate of the surgical intervention is high, the complications, for example, a digital nerve injury, bowstringing, infection and continued triggering, have been reported. Percutaneous release with an 18 guage needle has been reported as a safe and effective procedure for the trigger fingers. This study evaluates the safety and efficacy of the percutaneous release. METHODS: 33 patients received the percutaneous release of the A1 pulley with an 18 guage needle and steroid injection (Group A) and 36 patients did the only administration of steroid as a control group (Group B). Patients were examined with a clinical staging for the Watanabe stage (W stage) and 0-10 points verbal numerical rating scale (VNRS) score at 1 week, 3 months, 1 year after the initial treatment. RESULTS: After 1 year of the follow-up, 93.5% in the group A and 57.6% in the group B had complete release of the trigger fingers in the W stage. VNRS after the initial treatment demonstrated that the decrement of the pain score was more significant in the group A. CONCLUSIONS: We need to consider the percutaneous release with steroid injection at an early stage of the trigger fingers because of the more effective resolution of the symptoms and the better long-term prognosis than a steroid injection alone.
Asunto(s)
Humanos , Dedos , Estudios de Seguimiento , Agujas , Pronóstico , Férulas (Fijadores)RESUMEN
Morbid obesity presents many clinical problems. Especially, morbid obesity has a significant effect on airway management and pulmonary function. We experienced a cardiac arrest of a morbidly obese (Body Mass Index of about 62 kg/m2). 21-year-old male patient that necessitated cardiopulmonary resuscitation (CPR). The patient was scheduled for an emergency cystoscopy under local anesthesia. After change to supine position in the operation room, dyspnea, tachypnea, agitation, and, subsequently, cardiac arrest developed.
Asunto(s)
Humanos , Masculino , Adulto Joven , Manejo de la Vía Aérea , Anestesia Local , Reanimación Cardiopulmonar , Cistoscopía , Dihidroergotamina , Disnea , Urgencias Médicas , Paro Cardíaco , Obesidad Mórbida , Posición Supina , TaquipneaRESUMEN
Prader-Willi syndrome is a genetic disorder characterized by infantile hypotonia, childhood obesity, characteristic facial appearance, mental retardation, hypogonadism and short stature. It is described as a 2-stage disorder with an infantile hypotonic phase, followed by a childhood obese phase. The first phase, during the newborn and infancy period, is characterized by marked hypotonia, poor sucking, swallowing, coughing, crying, and episodes of asphyxia. Since these signs of poor strength cause poor reversal in the postoperative period, muscle relaxants should be used cautiously, especially in patients in the first phase of the syndrome. We experienced the anesthetic management of a 5-month-old female patient with Prader-Willi syndrome under general anesthesia, without muscle relaxant for excision of BCG lymphadenitis and a preauricular mass.
Asunto(s)
Femenino , Humanos , Lactante , Recién Nacido , Anestesia General , Asfixia , Tos , Llanto , Deglución , Hipogonadismo , Discapacidad Intelectual , Linfadenitis , Hipotonía Muscular , Músculos , Mycobacterium bovis , Obesidad , Periodo Posoperatorio , Síndrome de Prader-WilliRESUMEN
Unidirectional valve malfunction causes re-breathing of expired gas during anesthesia. Capnography is a useful method for monitoring the integrity of anesthetic equipment such as the unidirectional valves in a circular system. We report, here a case in which the capnography did not sound any rebreathing alarm, but the capnogram showed a prolonged plateau, an apparently short inspiratory period and a gradually sloping descending limb that stopped just short of baseline. As a result, capnography helped to identify an inspiratory unidirectional valve malfunction during the course of anesthesia. This study emphasizes the need to analyze the capnogram during every procedure involving anesthesia, in addition to preoperative checking of the Unidirectional valve.
Asunto(s)
Anestesia , Capnografía , ExtremidadesRESUMEN
The prone position during anesthesia sometimes causes hemodynamic changes such as a decrease in blood pressure. These changes are caused by a decrease in venous return from venous pooling in the legs, and decreased left ventricular compliance secondary to increased intrathoracic pressure, when patients are placed prone with an Andrews frame. We report on a patient who experienced cardiac arrest in the prone position with the Andrews frame during lumbar laminectomy and posterior lumbar interbody fusion. After 1.25 h in the prone position, bradycardia and hypotension occurred. Ephedrine, atropine and epinephrine were infused intravenously, but bradycardia and hypotension progressed to asystole. Cardioinhibitory reflex was likely triggered by decreased venous return and increased intrathoracic pressure, and the patient developed cardiac arrest as a result.
Asunto(s)
Humanos , Anestesia , Atropina , Presión Sanguínea , Bradicardia , Adaptabilidad , Efedrina , Epinefrina , Paro Cardíaco , Hemodinámica , Hipotensión , Laminectomía , Pierna , Posición Prona , Reflejo , Columna VertebralRESUMEN
Mitochondrial dysfunction represents a biochemically and clinically diverse group of conditions that can affect any organs with high energy requirement such as brain and muscle being particularly vulnerable. Pyruvate dehydrogenase complex (PDHC) deficiency is one type of mitochondrial dysfuntion that is anesthetically associated with lactic acidosis, muscle hypotonia, malignant hyperthermia, and postoperative respiratory failure. We report a case of general anesthetic management during ventriculoperitoneal shunt in a pediatric patient with PDHC deficiency and its possible considerations.
Asunto(s)
Humanos , Acidosis Láctica , Encéfalo , Hipertermia Maligna , Hipotonía Muscular , Músculos , Complejo Piruvato Deshidrogenasa , Ácido Pirúvico , Insuficiencia Respiratoria , Derivación VentriculoperitonealRESUMEN
Mitochondrial dysfunction represents a biochemically and clinically diverse group of conditions that can affect any organs with high energy requirement such as brain and muscle being particularly vulnerable. Pyruvate dehydrogenase complex (PDHC) deficiency is one type of mitochondrial dysfuntion that is anesthetically associated with lactic acidosis, muscle hypotonia, malignant hyperthermia, and postoperative respiratory failure. We report a case of general anesthetic management during ventriculoperitoneal shunt in a pediatric patient with PDHC deficiency and its possible considerations.
Asunto(s)
Humanos , Acidosis Láctica , Encéfalo , Hipertermia Maligna , Hipotonía Muscular , Músculos , Complejo Piruvato Deshidrogenasa , Ácido Pirúvico , Insuficiencia Respiratoria , Derivación VentriculoperitonealRESUMEN
Amyotrophic lateral sclerosis (ALS) is a progressive, neurodegenerative disorder involving primarily motor neurons in the cerebral cortex, brain stem and spinal cord, which leads to respiratory failure and death. The impairment of respiratory function, together with weakened upper airway muscles, may affect anesthetic management. The response to muscle relaxants, either depolarizing or nondepolarizing, is also altered in patients with ALS. Patients with ALS require special care throughout the perioperative period. We experienced the anesthetic management of a 63-year-old female patient with ALS under general anesthesia without the use of muscle relaxants for closed reduction with percutaneous screw fixation to treat a right femur neck fracture.
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Esclerosis Amiotrófica Lateral , Anestesia General , Tronco Encefálico , Corteza Cerebral , Fracturas del Cuello Femoral , Éteres Metílicos , Neuronas Motoras , Músculos , Enfermedades Neurodegenerativas , Periodo Perioperatorio , Piperidinas , Propofol , Insuficiencia Respiratoria , Médula EspinalRESUMEN
Amyotrophic lateral sclerosis (ALS) is a progressive, neurodegenerative disorder involving primarily motor neurons in the cerebral cortex, brain stem and spinal cord, which leads to respiratory failure and death. The impairment of respiratory function, together with weakened upper airway muscles, may affect anesthetic management. The response to muscle relaxants, either depolarizing or nondepolarizing, is also altered in patients with ALS. Patients with ALS require special care throughout the perioperative period. We experienced the anesthetic management of a 63-year-old female patient with ALS under general anesthesia without the use of muscle relaxants for closed reduction with percutaneous screw fixation to treat a right femur neck fracture.
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Esclerosis Amiotrófica Lateral , Anestesia General , Tronco Encefálico , Corteza Cerebral , Fracturas del Cuello Femoral , Éteres Metílicos , Neuronas Motoras , Músculos , Enfermedades Neurodegenerativas , Periodo Perioperatorio , Piperidinas , Propofol , Insuficiencia Respiratoria , Médula EspinalRESUMEN
Postdural puncture headache is the most common complication of unintentional dural puncture with an epidural needle. We present here the case of a 44-year-old woman who developed a severe headache from pneumocephalus, which was the result of an epidural blood patch procedure being performed to treat a PDPH. Both the epidural block and the autologous blood patch procedure were done at the L4-5 interspinous space with the loss of resistance technique and using air. After the epidural blood patch procedure, the headache was not relieved at the supine position and the computerized tomographic brain scan revealed the presence of air within the intracranial cavities. After conservative treatment, she was discharged from the hospital on the fourth-day without any neurologic sequelae.
Asunto(s)
Adulto , Femenino , Humanos , Parche de Sangre Epidural , Encéfalo , Cefalea , Agujas , Neumocéfalo , Cefalea Pospunción de la Duramadre , Punciones , Posición SupinaRESUMEN
Postdural puncture headache is the most common complication of unintentional dural puncture with an epidural needle. We present here the case of a 44-year-old woman who developed a severe headache from pneumocephalus, which was the result of an epidural blood patch procedure being performed to treat a PDPH. Both the epidural block and the autologous blood patch procedure were done at the L4-5 interspinous space with the loss of resistance technique and using air. After the epidural blood patch procedure, the headache was not relieved at the supine position and the computerized tomographic brain scan revealed the presence of air within the intracranial cavities. After conservative treatment, she was discharged from the hospital on the fourth-day without any neurologic sequelae.
Asunto(s)
Adulto , Femenino , Humanos , Parche de Sangre Epidural , Encéfalo , Cefalea , Agujas , Neumocéfalo , Cefalea Pospunción de la Duramadre , Punciones , Posición SupinaRESUMEN
Myoclonus is one of the rare complications after the neuroaxial blockade. We report a patient who developed propriospinal myoclonus following cervical epidural steroid injection. An outpatient, 73-years-old man, complaining of a tingling sensation from the right shoulder of supraspinatous region to the ipsilateral hand, particularly along the C6 dermatome, visited our pain clinic center. In cervical magnetic resonance imaging scan, the disc between 6th and 7th cervical vertebrae was herniated and pressed the nerves to the right side. We performed cervical epidural steroid injection, using triamcinolone acetonide 40 mg with 0.25% bupivacaine HCL 5 ml. After the first injection, he had no problem, but following the second injection, myoclonic movements were developed and lasted for 6 hours along only the right side of the whole body without other neurologic complications. The myoclonic movement improved by intravenous injection of clonazepam 0.5 mg and the patient completely recovered without any neurologic sequelae on that day.
Asunto(s)
Femenino , Humanos , Bupivacaína , Vértebras Cervicales , Clonazepam , Mano , Inyecciones Intravenosas , Imagen por Resonancia Magnética , Mioclonía , Pacientes Ambulatorios , Clínicas de Dolor , Sensación , Hombro , Triamcinolona AcetonidaRESUMEN
Myoclonus is one of the rare complications after the neuroaxial blockade. We report a patient who developed propriospinal myoclonus following cervical epidural steroid injection. An outpatient, 73-years-old man, complaining of a tingling sensation from the right shoulder of supraspinatous region to the ipsilateral hand, particularly along the C6 dermatome, visited our pain clinic center. In cervical magnetic resonance imaging scan, the disc between 6th and 7th cervical vertebrae was herniated and pressed the nerves to the right side. We performed cervical epidural steroid injection, using triamcinolone acetonide 40 mg with 0.25% bupivacaine HCL 5 ml. After the first injection, he had no problem, but following the second injection, myoclonic movements were developed and lasted for 6 hours along only the right side of the whole body without other neurologic complications. The myoclonic movement improved by intravenous injection of clonazepam 0.5 mg and the patient completely recovered without any neurologic sequelae on that day.
Asunto(s)
Femenino , Humanos , Bupivacaína , Vértebras Cervicales , Clonazepam , Mano , Inyecciones Intravenosas , Imagen por Resonancia Magnética , Mioclonía , Pacientes Ambulatorios , Clínicas de Dolor , Sensación , Hombro , Triamcinolona AcetonidaRESUMEN
Cornelia de Lange syndrome (CdLS) is a relatively uncommon, multiple malformation syndrome involving neurodevelopmental, craniofacial, cardiac, musculoskeletal and gastrointestinal systems. Anesthetic management of a patient with CdLS may pose a serious problem mainly from difficult tracheal intubation, aspiration complications and cardiac malformation. We report our successful experience in anesthetic management of a 15-month-old male patient with CdLS who underwent orchiopexy for bilateral cryptochidism.
Asunto(s)
Humanos , Lactante , Masculino , Síndrome de Cornelia de Lange , Intubación , OrquidopexiaRESUMEN
Goldenhar's syndrome is a rare form of a hemifacial microsomia in which the facial and vertebral anomalies are frequently associated with cardiac, pulmonary and renal defects. Infants with Goldenhar's syndrome commonly have an airway that is difficulty to manage. A difficult tracheal intubation may be due to a combination of mandibular hypoplasia, macrognathia, palatal defects and vertebral anomalies. We report the successful anesthetic management of a 10-month-old girl with Goldenhar's syndrome for the excision of conjunctival lipodermoid. The use of remifentanil followed with an anesthetic induction dose of propofol provides adequate conditions for tracheal intubation without the use of neuromuscluar blocking agents in a patient with Goldenhar's syndrome.
Asunto(s)
Femenino , Humanos , Lactante , Manejo de la Vía Aérea , Síndrome de Goldenhar , Intubación , PropofolRESUMEN
Ehlers-Danlos syndrome (EDS) is an inherited connective tissue disorder characterized by skin hyperelasticity, joint hypermobility and tissue fragility. The clinical manifestations vary depending on the type of disease. Due to multi-organ involvement and varied clinical presentations, no uniform anesthetic recommendations can be made. We report a case of a patient with EDS of an unknown type who successfully underwent an emergency cesarean section under general anesthesia.