RESUMO
We experienced a case of acute cerebral infarction during spinal anesthesia. The patient was a seventy years old male with diagnosis of right femur periprosthetic fracture scheduled for a open reduction & internal fixation under spinal anesthesia. Intraoperatively, he developed a mental confusion and his blood pressure decreased from 115/70 mmHg to 80/45 mmHg. After operation, he appeared to have left hemiparesis and left facial palsy. Angiogram revealed thrombus in superior division of the right middle cerebral artery. He expired 3 months after the surgery despite supportive measures.
Assuntos
Humanos , Masculino , Raquianestesia , Pressão Sanguínea , Infarto Cerebral , Diagnóstico , Paralisia Facial , Fêmur , Artéria Cerebral Média , Paresia , Fraturas Periprotéticas , TromboseRESUMO
Hypoglossal nerve palsy is a rare complication after general anesthesia with orotracheal intubation. It can present with symptoms of tongue deviation, dysarthria and swallowing difficulties. We report 33-year-old female who was scheduled to undergo surgery for a nasal bone fracture under general anesthesia, using orotracheal intubation. After surgery, she complained right side tongue deviation and, dysarthria, and was diagnosed with right hypoglossal nerve palsy. The cause of the hypoglossal nerve palsy was assumed to be a complication of the orotracheal intubation. Fortunately, the patient fully recovered 2 weeks after surgery.
Assuntos
Adulto , Feminino , Humanos , Anestesia Geral , Deglutição , Disartria , Doenças do Nervo Hipoglosso , Nervo Hipoglosso , Intubação , Osso Nasal , LínguaRESUMO
Lingual thyroid is a rare clinical entity that is due to the failure of the thyroid gland to descend early in the course of embryogenesis. It may be present with symptoms of dysphagia and upper airway obstruction. We report here on the case of a 63-year-old female who was scheduled for an operation for lumbar disc herniation and she could not be intubated. The cause of the airway obstruction was an ectopic thyroid at the base of the tongue, which made visualization of the glottis impossible. Several attempts at endotracheal intubation were unsuccessful. Fortunately, the patient was mask ventilated. We awakened the patient and consulted an otolaryngologist, and she was diagnosed with lingual thyroid. After a week, she was operated on using spinal anesthesia.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Obstrução das Vias Respiratórias , Raquianestesia , Transtornos de Deglutição , Desenvolvimento Embrionário , Glote , Intubação , Intubação Intratraqueal , Tireoide Lingual , Máscaras , Disgenesia da Tireoide , Glândula Tireoide , LínguaRESUMO
BACKGROUND: COPA (cuffed oropharyngeal airway) is a convenient device for airway management in patients undergoing general anesthesia for elective surgery in supine position. It causes less pharyngeal trauma than LMA (Laryngeal mask airway). The purpose of this study was to compare the effect of COPA with and without muscle relaxant. METHODS: Forty patients with ASA physical status I and II for elective surgery were randomly assigned to two groups. Anaesthesia was induced with propofol (2 mg/kg) and vecuronium (1.5 mg/kg) and was administered intravenously in Group I but not in Group II. Mask ventilation was done for 5 min with O2 5 L/min. COPA was placed and heart rate, and systolic, mean, diastolic blood pressure and peak inspiratory pressure were measured at 1 min interval for 5 min. Anaesthesia was maintained with propofol 150 microgram/kg/min, fentanyl 1 microgram/kg/hr, O2 2 L/min and N2O 2 L/min. RESULTS: There were no significant differences between Group I and Group II in heart rate, systolic, mean and diastolic blood pressure. PIP (Peak inspiratory pressure) was increased and hiccups occurred significantly (p < 0.05) in Group II. Complete airway obstruction occurred in one patient of Group I and severe coughing, body movements and gagging occurred during induction and insertion in Group II. CONCLUSIONS: With the use of appropriate muscle relaxant, we can use COPA without increased inspiratory pressure or significant complication.
Assuntos
Humanos , Manuseio das Vias Aéreas , Obstrução das Vias Respiratórias , Anestesia Geral , Pressão Sanguínea , Tosse , Fentanila , Engasgo , Frequência Cardíaca , Soluço , Máscaras , Propofol , Decúbito Dorsal , Brometo de Vecurônio , VentilaçãoRESUMO
BACKGROUND: For most patients, recovery from anesthesia is a smooth uneventful. But for some, recovery can be life threatening. To prevent this, adequate and prompt evaluation of patients on recovery state is essential. Activity, respiration, circulation, awareness, and color are comprehensively assessed by PAR score. So we performed this clinical study to compare ongoing changes in PAR score and the effects of age, physical status, operation site and operation time on PAR score were evaluated. METHODS: Two hundred and fifty-four patients (ASA 1, 2) undergoing elective surgery under general anesthesia were evaluated in our recovery room. They were anesthetized with enflurane or isoflurane, and nitrous oxide, and were transferred to the recovery room when SpO2 was more than 97% and there was no supplemental oxygen during transport. Once there, O2 5 l/min was administered via a face mask to all the patients. Assessment of each patient's PAR score was made at ten-minute intervals by the same anesthesiologist. RESULTS: Emergence from anesthesia was significantly dependent on patient's age, preoperative physical status but not on operation site and time. PAR score was significantly increased according to PAR-stay time regardless of age, physical status, operation site or time. CONCLUSION: In evaluating the postanesthetic recovery state, it seems to be important to consider patient's age and physical status.
Assuntos
Humanos , Anestesia , Anestesia Geral , Enflurano , Isoflurano , Máscaras , Óxido Nitroso , Oxigênio , Sala de Recuperação , RespiraçãoRESUMO
The surgical and anesthetic management for giant cerebral aneurysm is difficult because of their great size or lack of an anatomic neck. Recently, total circulatory arrest, profound hypothermia using cardiopulmonary bypass and the cerebral protection of barbiturate are able to manage the difficult cerebral aneurysm operation due to the ease of the surgical approach and the decreased post operative neurological injury. These techniques were successfully utilized in the patient of the diamerer-3 cm sized giant cerebral aneurysm located at the bifurcation between the right internal carotid artery and the anterior cerebral artery, and the surgical and anesthetic considerations are reviewed.