ABSTRACT
We experienced anesthetic management for an operation to remove a hemorrhagic gastric submucosal tumor in a patient who had undergone left ventricular volume reduction (the Batista procedure) for dilated cardiomyopathy (DCM) 2 years previously. Preoperative evaluations indicated the relapse of severe DCM. Intravenous and epidural anesthesia was employed with the aid of an intraaortic balloon pump (IABP). Safe anesthetic management was achieved under the guidance of a Swan-Ganz catheter without inducing overreduction of afterload or excessive preload.
Subject(s)
Anesthesia, Epidural/methods , Anesthesia, General/methods , Cardiomyopathy, Dilated/complications , Gastric Mucosa/surgery , Stomach Neoplasms/surgery , Anesthetics, Intravenous/administration & dosage , Anesthetics, Local/administration & dosage , Bupivacaine/administration & dosage , Catheterization, Swan-Ganz/methods , Diabetes Complications/complications , Fentanyl/administration & dosage , Heart Ventricles/surgery , Humans , Intra-Aortic Balloon Pumping/methods , Kidney Failure, Chronic/complications , Male , Midazolam/administration & dosage , Middle Aged , Neuromuscular Nondepolarizing Agents/administration & dosage , Propofol/administration & dosage , Recurrence , Vecuronium Bromide/administration & dosageABSTRACT
A 76-year-old woman was scheduled to undergo a laser resection of the tracheal tumor which severely obstructed the upper airway. She had a past history of thoracic aortic aneurysm resection and myocardial infarction. After spraying the patient's oral cavity with 8% lidocaine, a laryngeal mask airway was inserted under spontaneous respiration. Tumor resection was successfully performed using CO2 laser through the laryngeal mask airway with the aid of low dose fentanyl under spontaneous respiration. Maintaining FIO2 at 0.5 could prevent hypoxemia. Although mild edema was observed in the larynx at the completion of the surgery, the patient achieved remarkable improvement in her breathing status. Consequently, she was able to undergo radiotherapy on the 5th postoperative day. This effectively reduced the tumor volume.
Subject(s)
Airway Obstruction/etiology , Laryngeal Masks , Laser Therapy , Tracheal Neoplasms/surgery , Aged , Airway Obstruction/physiopathology , Female , Humans , Respiration , Tracheal Neoplasms/complications , Tracheal Neoplasms/physiopathologyABSTRACT
A 34-year-old obese, small-jawed and short-necked woman, had severe obstructive sleep apnea syndrome (OSAS) with bronchial asthma. A surgical removal of a lingual tumor using a laser knife was scheduled under general anesthesia with sevoflurane. A small diameter tracheal tube for laser surgery (internal diameter (ID) of 5.5 mm) was used. The tube was inserted using bronchofiberscopy under spontaneous respiration. Extubation was designed to be performed when the patient resumed adequate spontaneous respiration and was awake. However, her ventilation deteriorated postoperatively as spontaneous breathing continued (PaO2 98 mmHg, PaCO2 88 mmHg at FIO2 1.0). This seemed to have been induced by worsened patient-ventilator synchrony and increased airway resistance due to the use of a small diameter tube. We decided to replace the tube with the one with larger diameter. An ID 7.5 mm tube was inserted with the use of fiberscope through the opening of the vocal cord while the tube for laser surgery was left in space. After confirming that the two tubes were inserted securely, the tube for laser surgery was withdrawn. The patient's ventilation improved significantly afterwards and the extubation was performed successfully. Our method for replacing a tracheal tube seemed to be effective and safe.
