RESUMO
High-dose steroid therapy is known as effective adjuvant therapy for refractory bone pain due to metastasis of solid cancer. However, the standard dose and duration have not been established to date. Long term maintenance with steroid therapy is not encouraged due to its potential adverse effects. Here, we report a case of a terminal cancer patient who maintained high dose steroid therapy to alleviate refractory bone pain with complication of systemic fungal infection.
Assuntos
Humanos , Candida , Metástase Neoplásica , EsteroidesRESUMO
Porphyrias are inherited metabolic disorders resulting from a specific enzyme defect in the heme biosynthetic pathway. Porphyrias are induced by various precipitants. Clinical features include abdominal pain, neurologic manifestations, autonomic neuropathy, and mental disturbance. Diagnosis may be delayed because of variable symptoms that mimic other diseases and because of the rarity of of porphyrias. Although most patients with known porphyria can complete anesthesia and surgery safely, undiagnosed porphyric patients are in danger of porphyric crisis due to inadvertent exposure to precipitating drugs and environment. We report a case of a patient who experienced delayed emergence with neurological disturbance after general anesthesia, ultimately diagnosed as acute intermittent porphyria.
Assuntos
Humanos , Dor Abdominal , Anestesia , Anestesia Geral , Vias Biossintéticas , Recuperação Demorada da Anestesia , Diagnóstico , Síndrome de Guillain-Barré , Heme , Manifestações Neurológicas , Porfiria Aguda Intermitente , Porfirias , Coluna Vertebral , Encefalopatia de WernickeRESUMO
No abstract available.
Assuntos
Humanos , Colecistectomia Laparoscópica , Mosaicismo , Síndromes Mielodisplásicas , TrissomiaRESUMO
Although fentanyl-induced cough is generally transient and benign, it can give rise to serious problems in patients to whom increasing intracranial, intraocular or intraabdominal pressures may create dangerous situations. This case demonstrates aspiration pneumonia as a complication, exhibiting severe cough induced by intravenous injection of fentanyl.
Assuntos
Humanos , Tosse , Fentanila , Injeções Intravenosas , Pneumonia , Pneumonia Aspirativa , VômitoRESUMO
Tapia's syndrome is the palsy of the 10th and 12th cranial nerves, resulting in ipsilateral paralysis of the vocal cord and tongue. It is a rare complication which is related to the anesthetic airway management and positioning of the patient's head during the surgery. We describe a patient with a postoperative unilateral Tapia's syndrome, after general anesthesia, with uncomplicated endotracheal intubation. The patient's symptoms improved gradually for three months.
Assuntos
Humanos , Manuseio das Vias Aéreas , Anestesia Geral , Nervos Cranianos , Cabeça , Intubação Intratraqueal , Paralisia , Língua , Prega VocalRESUMO
We report a case of an erroneously elevated bispectral index (BIS) during robot assisted thyroidectomy using an electromyographic endotracheal tube (EMG tube), which is safe and useful for laryngeal electromyographic monitoring. Ten minutes after start of the operation, a sudden increase of BIS value up to 98 was noticed. The BIS values were not decreased to < 65 with supplemental anesthetics. The anesthetic method was changed from total intravenous anesthesia to balanced anesthesia. The BIS sensor and monitor were changed and other models were used. These interventions did not alter BIS values. BIS levels remained between 60 and 70 throughout the main procedure and intermittently increased to the mid-90s without any trace of poor signal quality. At the end of the surgery, the BIS values returned to normal range. The patient did not complain of intraoperative recall. Knowledge of potential interference from the use of an EMG tube must be considered when interpreting BIS.
Assuntos
Humanos , Anestesia Intravenosa , Anestésicos , Anestesia Balanceada , Compostos Organotiofosforados , Valores de Referência , TireoidectomiaRESUMO
One-lung ventilation with a double-lumen endotracheal tube or a Univent(R) tube may be difficult or dangerous in small patients, children, and patients with anatomic abnormalities of the airway. The use of a bronchial blocker through a single-lumen endotracheal tube has been used successfully in such situations. A 69-year-old woman was scheduled for Ivor-Lewis operation and right upper lobectomy. She could not be intubated with a internal diameter 6.0 mm Univent(R) tube owing to narrow diameter of the vocal cord. We report a successful one-lung ventilation using a Uniblocker(R) through an adult-size single-lumen endotracheal tube in a small woman, who needed postoperative ventilator care.
Assuntos
Idoso , Criança , Feminino , Humanos , Ventilação Monopulmonar , Ventiladores Mecânicos , Prega VocalRESUMO
Electromyogpraphic endotracheal tube (EMG tube) is a new device used to monitor recurrent laryngeal nerve integrity during thyroid surgery. The EMG tube has 2 pairs of electrodes on the surface of silicon-based tube reached to inner space of tube cuff. We experienced an unusual endotracheal tube-related problem from the distinct structural feature of the EMG tube. In this case, we intubated a patient who had difficult airway with the EMG tube using a lightwand. After successful endotracheal intubation, we could not expand the pilot balloon and ventilate the patient effectively. We removed the EMG tube and found that one of electrodes of the EMG tube is bended and made a right angle with the long axis of the tube, and perforated the tube cuff. So we report this case to make anesthesia providers aware that much more attention is needed to use EMG tube during endotracheal intubation.
Assuntos
Humanos , Anestesia , Vértebra Cervical Áxis , Eletrodos , Intubação , Intubação Intratraqueal , Compostos Organotiofosforados , Nervo Laríngeo Recorrente , Glândula TireoideRESUMO
BACKGROUND: The aim of this study was to investigate the management of pediatric patients who were referred to the pain center. METHODS: The data was collected based on 32 pediatric patients referred to the pain center from March 2002 to August 2006. The number of patients each year, gender distribution, age, requested departments, clinical causes of consultation, and the pain management before and after the consultation were analyzed retrospectively. RESULTS: 32 pediatric patients (19 males and 13 females), aged 3- 17 years, were enrolled in this study. Fifty-six percent of patients were in adolescence. The major need for the consultation was cancer pain (50.0%), myofascial pain syndrome (10.0%) and central pain (10.0%). Before the consultation, 62.1% of the patients were managed by opioid-based medications of which 26.1% were managed by only partial agonists and 29.6% were managed by only PRN. At the pain center, opioid-based medication was also the main treatment. CONCLUSIONS: The number of pediatric patients referred to the pain center has increased. Under this condition, the pain physician should be concerned about pediatric pain patients and their management.
Assuntos
Adolescente , Humanos , Masculino , Distribuição por Idade , Síndromes da Dor Miofascial , Clínicas de Dor , Manejo da Dor , Estudos RetrospectivosRESUMO
BACKGROUND: In this randomized, double-blinded study, we evaluated the efficacy of ramosetron and ondansetron for preventing postoperative nausea and vomiting (PONV) in gynecologic patients. METHODS: Sixty patients undergoing total abdominal hysterectomy or myomectomy, ASA physical status I or II, aged 30-65 yr, received IV ramosetron 0.3 mg (group R) or ondansetron 4 mg (group O) at the end of surgery (n = 30 each). A standard general inhalational anesthesia and postoperative IV patient-controlled analgesia were used. At postoperative 3, 24 and 48 hours, we assessed pain score (VAS), incidence of PONV, rescue drug consumption, adverse events associated with study medications and overall satisfaction scores. RESULTS: The incidence of PONV showed no difference between groups at each time points after surgery (overall incidence; 59% in group R, 69% in group O). There was no difference in the severity of nausea, pain score and analgesic drug usage. However, the consumption of rescue drug in the ramosetron group was markedly less than that of ondansetron group at postoperative 3 hrs (none vs. 8 patients). No clinically serious adverse events were observed in either of the groups. Overall satisfaction scores were also comparable in both groups (6.5 +/- 3.0 vs. 6.2 +/- 2.7). CONCLUSIONS: Prophylactic therapy with ramosetron is as effective and safe as conventional prophylactic therapy with ondansetron for preventing PONV in women undergoing general anesthesia for gynecologic surgery. Severity of PONV seems significantly less with ramosetron than with ondansetron in the early postoperative period.
Assuntos
Feminino , Humanos , Analgesia Controlada pelo Paciente , Anestesia , Anestesia Geral , Procedimentos Cirúrgicos em Ginecologia , Histerectomia , Incidência , Náusea , Ondansetron , Náusea e Vômito Pós-Operatórios , Período Pós-Operatório , VômitoRESUMO
A case of an epidural abscess, a rare but possibly devastating complication of epidural instrumentation and catheterization, which occurred in a cancer pain patient with an epidural port connected to the epidural catheter, is described. Although cases of a catheter related epidural abscess have been intermittently reported, those following epidural port implantation are very rare, with no case having been reported in Korea. Herein, the case of a 31-year-old man, who developed an epidural abscess 54 days after subcutaneous implantation of an epidural port connected to an epidural catheter, is reported. Methicillin-sensitive staphylococcus aureus was detected in a culture of the purulent discharge. Magnetic resonance imaging was essential, not only for the diagnosis of the epidural abscess, but also for determining the extent of spread. The patient refused further evaluation and treatment, and expired 22 days later.