RESUMO
The airway management of patients with subglottic stenosis poses many challenges for the anesthesiologists. Many anesthesiologists use a narrow endotracheal tube for airway control. This, however, can lead to complications such as tracheal mucosal trauma, tracheal perforation or bleeding. The ASA difficult airway algorithm recommends the use of supraglottic airway devices in a failed intubation/ventilation scenario. In this report, we present a case of failed intubation in a patient with subglottic stenosis successfully managed during an i-gel(TM) supraglottic airway device. The device provided a good seal, and allowed for controlled mechanical ventilation with acceptable peak pressures while the patient was in the beach-chair position.
Assuntos
Humanos , Manuseio das Vias Aéreas , Constrição Patológica , Hemorragia , Intubação , Respiração ArtificialRESUMO
A 15-year-old adolescent with unilateral multiple adrenal pheochromocytoma had an episode of subcortical intracerebral hemorrhage and seizure 6 weeks before the surgery. He was pretreated with terazosin, losartan, atenolol and levetiracetam for 2 weeks. Dexmedetomidine was started in the preoperative waiting area, and a combination of dexmedetomidine and remifentanil was continuously infused for most of anesthetic time. To control blood pressure, bolus injection of remifentanil and low-dose infusion of sodium nitroprusside, nicardipine, and esmolol were administered during three adrenergic crises. There was minimal post-resection hypotension, and his trachea was extubated safely 20 min after the surgery. He was discharged without noticeable complication. His catecholamine levels showed the steadily decreasing pattern during the operation in this case. Though a combination of dexmedetomidine and remifentanil may not prevent the hemodynamic instability impeccably during the tumor manipulation, this combination seems to be the way of interrupting release of catecholamines and minimizing hemodynamic fluctuations.
Assuntos
Adolescente , Humanos , Atenolol , Pressão Sanguínea , Catecolaminas , Hemorragia Cerebral , Dexmedetomidina , Hemodinâmica , Hipotensão , Losartan , Nicardipino , Nitroprussiato , Feocromocitoma , Piperidinas , Piracetam , Prazosina , Propanolaminas , Convulsões , TraqueiaRESUMO
Anesthesiologists may encounter pulmonary thromboembolism during the perioperative period. However, the diagnosis of pulmonary thromboembolism is difficult because clinical symptoms and signs are not specific, and specialized diagnostic tools are not readily available in the operating room. We report a case of pulmonary thromboembolism during modified radical mastectomy. A 52 year old female patient underwent modified radical mastectomy under general anesthesia. 90 minutes after induction there were a sudden increase of peak airway pressure and a decrease of oxygen saturation. We treated symptomatically under the impression of pulmonary edema during operation. After operation, pulmonary thromboembolism was diagnosed and treated successfully with oxygen therapy and anticoagulant therapy. After 26th days of operation she was no longer suffered from hypoxia. At the 36th day after operation, she was discharged without any sequelae.