Dyspnea resulting from phrenic nerve paralysis after interscalene brachial plexus block in an obese male--a case report.

Phrenic nerve paralysis is a common complication in interscalene brachial plexus block. This complication is often ignored by most anesthesiologists because no clinical symptoms occur in patients who have no underlying lung disease. We present a case of an obese male suffering from dyspnea due to phrenic nerve block after interscalene brachial plexus block. The decreased respiratory reserve and direct compressing effect of the abdominal organs on the diaphragm in the supine position are thought to be the risk factors in this obese patient. Also discussed are the incidence, diagnostic methods, clinical presentation and treatments of phrenic nerve paralysis during interscalene brachial plexus block.

[Clinical assessment of desmopressin to reduce blood loss in patients after cardiopulmonary bypass].

Blood loss in patients on cardiopulmonary bypass is tremendously large after surgery due to platelet dysfunction. Desmopressin acetate (a synthetic analogue of vasopressin) has been shown to improve blood coagulation in a variety of platelet disorders especially in patients with hemophilia, von Willebrand's disease and uremia. Recent years, it has been used to treat patients with severe platelet dysfunction and profuse hemorrhage after cardiopulmonary bypass. We have investigated the effect of desmopressin acetate administration in randomized trials of 48 adult patients placed on cardiopulmonary bypass during cardiac surgery. Twenty four patients received intravenous infusion 0.3 microgram/kg desmopressin acetate one hour after cardiopulmonary bypass and other patients only received a placebo. Comparing with the control group, patients receiving desmopressin had shortened bleeding time (3.4 +/- 0.6 vs 5.1 +/- 1.6 mins, 8 hrs post bypass), lessened blood loss (482 +/- 258 ml vs 1430 +/- 733 ml, 24 hrs post bypass) and received fewer blood component therapy (pack RBC 2.7 +/- 2.2 vs 6.6 +/- 3.2 units, FFP 4.3 +/- 2.4 vs 11.7 +/- 5.7 units, platelet 3.8 +/- 5.0 vs 8.4 +/- 7.2 units). We conclude that desmopressin acetate can improve blood coagulation ability with safety and in reducing blood loss in patients after cardiopulmonary bypass.

[Anesthetic considerations in complete obstruction of major veins of upper trunk--report of two cases].

This article presents two cases about complete obstruction of major veins of upper trunk. One was a 45 year-old woman who suffered from complete obstruction of superior vena cava due to bronchogenic carcinoma. Venous bypass grafting from left innominate vein to right atrium was performed. The other was a 41 year-old man. Both of his right and left, internal and external jugular veins were completely obstructed after radical laryngectomy and radiotherapy due to hypopharyngeal carcinoma. Venous bypass grafting from cerebral transverse sinus to right atrium was performed. In both cases, general anesthesia with neurosurgical anesthetic concepts were performed with continuous blood pressure monitoring, CVP monitoring, pulse oximetry, end-tidal CO2 monitoring, blood gas analysis, urine output and EKG monitoring. The outcome was satisfactory in both cases.