ABSTRACT
We report a case of a patient treated by retroperitoneoscopic partial nephrectomy who developed nitrogenous subcutaneous emphysema (SCE) as a complication. The use of a nitrogen gas-pressured fibrin tissue adhesive applied as a spray caused excessively increased pressure in the closed retroperitoneal space and resulted in widespread SCE with protracted clinical course. To the best of our knowledge, this is the first report of nitrogenous SCE associated with pneumoperitoneum. The clinical significance of nitrogenous SCE is emphasized, and the risks associated with the use of fibrin glue as a spray during laparoscopic surgery are discussed.
Subject(s)
Aerosol Propellants/adverse effects , Fibrin Tissue Adhesive/adverse effects , Laparoscopy , Nitrogen/adverse effects , Postoperative Complications/diagnostic imaging , Retroperitoneal Space/surgery , Subcutaneous Emphysema/chemically induced , Tissue Adhesives/adverse effects , Aerosols , Female , Fibrin Tissue Adhesive/administration & dosage , Humans , Kidney/surgery , Kidney Neoplasms/surgery , Middle Aged , Pneumoperitoneum/diagnostic imaging , Pneumoperitoneum/etiology , Postoperative Complications/therapy , Radiography, Thoracic , Retroperitoneal Space/diagnostic imaging , Subcutaneous Emphysema/diagnostic imaging , Tissue Adhesives/administration & dosageABSTRACT
Sevoflurane is widely used for its rapid onset and offset due to a lower blood/gas coefficient. However, involuntary movements, tachycardia, and hypertension have been observed in some patients despite a continuing constantly delivered concentration of sevoflurane during 1-lung ventilation (OLV), indicating the possibility of insufficient depth of anesthesia. We observed a temporary but obvious decrease in arterial sevoflurane concentration and pulse oximeter readings in a patient during OLV. This may have resulted in the depth of inhaled anesthesia being insufficient during OLV because the arterial sevoflurane concentration was lower than expected in spite of constantly delivered and inspiratory/expiratory sevoflurane concentrations.
Subject(s)
Anesthetics, Inhalation/blood , Hypoxia/etiology , Lung/blood supply , Methyl Ethers/blood , Pulmonary Artery/physiopathology , Pulmonary Circulation , Pulmonary Veins/physiopathology , Respiration, Artificial/adverse effects , Vasoconstriction , Aged , Anesthetics, Inhalation/administration & dosage , Anesthetics, Inhalation/pharmacokinetics , Dose-Response Relationship, Drug , Female , Humans , Hypoxia/blood , Hypoxia/physiopathology , Intraoperative Awareness/prevention & control , Male , Methyl Ethers/administration & dosage , Methyl Ethers/pharmacokinetics , Middle Aged , Monitoring, Intraoperative/methods , Oximetry , Pulmonary Circulation/drug effects , Sevoflurane , Vasoconstriction/drug effectsABSTRACT
Dengue fever, one of the common endemic viral fevers, often presents with fever, rash, and mild liver dysfunction. However, plasma leakage induced by dengue virus infection can lead to dengue hemorrhagic fever and dengue shock syndrome, and it can cause severe complications including liver failure and encephalopathy. Infection of dengue virus with other pathogens is an unusual but serious complication. We report a case of dengue shock syndrome with liver failure and impaired consciousness. The patient developed a disseminated Candida tropicalis infection, which may have been due to translocation of the fungus from the intestine damaged by the dengue virus.
