Recurrent postoperative aspiration following jugular foramen tumor resection

We report a 38 year old male patient who underwent a craniotomy for jugular foramen tumor resection. In the postoperative care unit, the patient developed aspiration accompanied with oxyhemoglobin desaturation. Subsequently, he had several episodes of recurrent aspiration which were attributed to cranial nerves [IX, X] palsy as a complication of the surgery at the jugular foramen. It is suggested that aspiration prophylactic measures should be taken and early assessment of lower cranial nerves function should be done prior to tracheal extubation to decrease post-operative aspiration in patients undergoing base of skull surgery

Multimodal spinal anesthesia

Cystoscopy and extracorporeal shock wave lithotripsy [ESWL] are common urologic procedures in the treatment of ureteral calculi. Spinal anesthesia with local anesthetics is the anesthetic technique of choice for these procedures. Sufentanil and/or clonidine have been combined with local anesthetics to provide effective and safe neuroaxial anesthesia. Our objectives were to review the efficacy and safety of combining both sufentanil and clonidine with reduced doses of intrathecal lidocaine in patients undergoing cystoscopy and ESWL. We reviewed the medical records of 12 patients who underwent such urologic procedures using an intrathecal mixture consisting of 20 mg of lidocaine, 10 micro g of sufentanil, and 50 micro g clonidine from May 1[st], 1998 to December 31[st], 1998. Patients' demographics, intraoperative analgesia and adverse side effects as well as recovery times were reviewed. All 12 patients tolerated their urologic treatments using this combination of drugs without requiring conversion to another anesthetic technique or significant supplementation with intravenous analgesics. Motor power returned to normal by the end of the procedure. The systolic blood pressure dropped 26 +/- 8% intraoperatively and 25 +/- 9% postoperatively. The incidences of other adverse side effects were low. Time spent in recovery area was short, 45 +/- 15 minutes [mean +/- standard deviation]. Conclusions: Intrathecal admixtures of sufentanil 10 micro g, clonidine 50 micro g, and lidocaine 20 mg can provide effective and prolonged analgesia in patients undergoing cystoscopy and ESWL. Patients had recovery of their motor power in their lower extremities by the end of the procedure. No urinary retention was noted. Mild hypotension was the most common adverse side effect and was the main confounding factor for the prolongation of the discharge time