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Background@#Mounier-Kuhn syndrome (MKS) is a rare disorder characterized by abnormal dilation of the trachea and main bronchi. MKS can be easily missed on chest X-rays, making diagnosis difficult. Under general anesthesia, challenges such as airway leakage or collapse during mechanical ventilation may prevent the achievement of adequate tidal volumes in patients with MKS.Case: A 94-year-old woman requiring emergency hemiarthroplasty of the hip under general anesthesia was admitted. Preoperative chest X-rays revealed dilation of the trachea and main bronchi, but the patient exhibited no respiratory symptoms. We diagnosed her with MKS and opted for an 8.0-mm-inner-diameter reinforced tracheal tube. We positioned the cuff in the subglottic area, inflating it while monitoring for air leakage. Throughout the surgery, we ensured that adequate air leak and tidal volume were maintained. @*Conclusions@#Anesthesiologists must conduct a comprehensive evaluation of patients with MKS, including a review of chest radiographs, and establish a meticulous anesthesia plan prior to surgery.
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No abstract available.
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BACKGROUND: The aim of this study was to evaluate the sedative effect of dexmedetomidine (DEX) added to ropivacaine for supraclavicular brachial plexus block (BPB) using the bispectral index (BIS). METHODS: Sixty patients (American Society of Anesthesiologists physical status 1 or 2, aged 20-65 years) undergoing wrist and hand surgery under supraclavicular BPB were randomly allocated to two groups. Ultrasound-guided supraclavicular BPB was performed with 40 ml of ropivacaine 0.5% and 1 microg/kg of DEX (Group RD) or 0.01 ml/kg of normal saline (Group R). The primary endpoint was the BIS change during 60 min after block. The secondary endpoint was the change in the mean arterial blood pressure (MAP), heart rate (HR), and SpO2 and the onset time and duration of the sensory and motor block. RESULTS: In Group RD, the BIS decreased significantly until 30 min after the block (69.2 +/- 13.7), but remained relatively constant to 60 min (63.8 +/- 15.3). The MAP, HR and BIS were significantly decreased compared with Group R. The onset time of the sensory and motor block were significantly faster in Group RD than in Group R. The duration of the sensory and motor block were significantly increased in Group RD. CONCLUSIONS: DEX added to ropivacaine for brachial plexus block induced sedation that corresponds to a BIS value of 60 from which patients are easily awakened in a lucid state. In addition, perineural DEX shortened the onset time and prolonged the duration of the sensory and motor blocks.
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Humans , Arterial Pressure , Brachial Plexus , Dexmedetomidine , Hand , Heart Rate , Hypnotics and Sedatives , WristABSTRACT
PURPOSE: The objective of this study was to evaluate our institutional experience with veno-venous (VV) extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory failure (ARF). MATERIALS AND METHODS: From January 2007 to August 2013, 31 patients with severe ARF that was due to various causes and refractory to mechanical ventilation with conventional therapy were supported with VV ECMO. A partial pressure of arterial oxygen (PaO2)/inspired fraction of oxygen (FiO2) <100 mm Hg at an FiO2 of 1.0 or a pH <7.25 due to CO2 retention were set as criteria for VV ECMO. RESULTS: Overall, 68% of patients survived among those who had received VV ECMO with a mean PaO2/FiO2 of 56.8 mm Hg. Furthermore, in trauma patients, early use of ECMO had the best outcome with a 94% survival rate. CONCLUSION: VV ECMO is an excellent, life-saving treatment option in patients suffering from acute and life-threatening respiratory failure due to various causes, especially trauma, and early use of VV ECMO therapy improved outcomes in these patients.
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Adult , Female , Humans , Male , Middle Aged , Acute Disease , Cause of Death , Extracorporeal Membrane Oxygenation , Respiratory Insufficiency/complications , Survival Analysis , Treatment OutcomeABSTRACT
This prospective study aimed to evaluate the satisfaction of patients who participated in the decision-making process for selecting an anesthesia method for surgery; the patients' preferred role (active, collaborative or passive) in the decision-making; and the patients' preferred choice of anesthetic method. The study included 257 patients scheduled for simple elective surgeries involving the upper or lower extremities. During the preanesthetic visit, patients were informed regarding two methods of anesthesia for their surgeries, and participated in selecting one option. Of the 257 patients, 69.6% preferred a collaborative role, 18.3% and 12.1% preferred an active and a passive role, respectively. Among patients requiring surgery on an upper extremity and on a lower extremity, 64.3% and 51.3% expressed a preference for general anesthesia over regional anesthesia, respectively. After surgery, the majority of our patients were satisfied (93.4%) and felt respected (97.7%). Furthermore, the patients expressed a change in preference for assuming an active role (49.4%) and a collaborative role (43.6%) in the decision-making process for their future anesthesia needs. This study may help to promote patient centered care in a department of anesthesiology.
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Adult , Aged , Female , Humans , Male , Middle Aged , Anesthesia, General , Decision Making , Extremities/surgery , Hospitals , Patient Care , Patient Preference , Patient Satisfaction , Physician-Patient Relations , Prospective StudiesABSTRACT
OBJECTIVE: The aim of this study was to evaluate effect of pulsed radiofrequency (PRF) neuromodulation of suprascpaular nerve (SSN) in patients with chronic shoulder pain due to adhesive capsulitis and/or rotator cuff tear. METHODS: The study included 11 patients suffering from chronic shoulder pain for at least 6 months who were diagnosed with adhesive capsulitis (n=4), rotator cuff tear (n=5), or adhesive capsulitis+rotator cuff tear (n=2) using shoulder magnetic resonance imaging or extremity ultrasonography. After a favorable response to a diagnostic suprascapular nerve block twice a week (pain improvement >50%), PRF neuromodulation was performed. Shoulder pain and quality of life were assessed using a Visual Analogue Scale (VAS) and the Oxford Shoulder Score (OSS) before the diagnostic block and every month after PRF neuromodulation over a 9-month period. RESULTS: The mean VAS score of 11 patients before PRF was 6.4+/-1.49, and the scores at 6-month and 9 month follow-up were 1.0+/-0.73 and 1.5+/-1.23, respectively. A significant pain reduction (p<0.001) was observed. The mean OSS score of 11 patients before PRF was 22.7+/-8.1, and the scores at 6-month and 9 month follow-up were 41.5+/-6.65 and 41.0+/-6.67, respectively. A significant OSS improvement (p<0.001) was observed. CONCLUSION: PRF neuromodulation of the suprascapular nerve is an effective treatment for chronic shoulder pain, and the effect was sustained over a relatively long period in patients with medically intractable shoulder pain.
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Humans , Adhesives , Bursitis , Chronic Pain , Extremities , Failed Back Surgery Syndrome , Follow-Up Studies , Magnetic Resonance Imaging , Nerve Block , Quality of Life , Rotator Cuff , Shoulder Pain , Shoulder , Spinal Cord Stimulation , UltrasonographyABSTRACT
Neurogenic pulmonary edema (NPE) leading to cardiopulmonary dysfunction is a potentially life-threatening complication in patients with central nervous system lesions. This case report describes a 28-yr woman with life-threatening fulminant NPE, which was refractory to conventional respiratory treatment, following the rupture of an aneurysm. She was treated successfully with extracorporeal membrane oxygenation (ECMO), although ECMO therapy is generally contraindicated in neurological injuries such as brain trauma and diseases that are likely to require surgical intervention. The success of this treatment suggests that ECMO therapy should not be withheld from patients with life-threatening fulminant NPE after subarachnoid hemorrhage.
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Adult , Female , Humans , Brain/diagnostic imaging , Decompressive Craniectomy , Extracorporeal Membrane Oxygenation , Intracranial Aneurysm/complications , Pulmonary Edema/diagnosis , Subarachnoid Hemorrhage/etiology , Tomography, X-Ray ComputedABSTRACT
PURPOSE: This prospective study evaluated the effects of continuous sedation using midazolam, with or without remifentanil, on postoperative nausea and vomiting (PONV) in patients undergoing myringoplasty. MATERIALS AND METHODS: Sixty patients undergoing myringoplasty were sedated with midazolam in the presence of remifentanil (group MR), or after saline injection instead of remifentanil (group M). RESULTS: Three patients (10%) in group M complained of nausea; two vomited. Four patients (13%) in group MR complained of nausea and vomited within 24 h after surgery. Rescue drugs were given to the six patients who vomited. No significant difference was detected between the two groups regarding the incidence or severity of nausea, incidence of vomiting, or need for rescue drugs. CONCLUSION: Midazolam-based continuous sedation can reduce PONV after myringoplasty. Compared with midazolam alone, midazolam with remifentanil produced no difference in the incidence or severity of nausea, incidence of vomiting, or need for rescue drugs.
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Humans , Incidence , Midazolam , Myringoplasty , Nausea , Postoperative Nausea and Vomiting , Prospective Studies , VomitingABSTRACT
Airway management in the emergency department is one of the most important responsibilities of the emergency physician and often involves cooperation with anesthesiologists and trauma surgeons. A 21-year-old woman was transferred to our emergency department for urgent trauma management following a motor vehicle accident. Her face was severely edematous, and her lower maxilla, including the alveoli, was separated from the upper maxilla. She was diagnosed with a Le Fort I fracture with a basal skull fracture. She also had epistaxis and oral bleeding. Her airway was difficult to manage; however, our trauma team, including anesthesiologists, managed her airway successfully in the emergency room.
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Female , Humans , Young Adult , Airway Management , Emergencies , Epistaxis , Hemorrhage , Maxilla , Motor Vehicles , Skull FracturesABSTRACT
We report a difficult case of tracheostomy in a 34-year-old obese woman with a short neck. The tracheostomy tube placement repeatedly failed because of anatomical changes due to obesity and a short neck, tracheal mucosal swelling due to prolonged intubation, and unexpected false passage; however, it was successfully performed using an endotracheal tube exchanger as a guidewire.
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Adult , Female , Humans , Intubation , Neck , Obesity , TracheostomyABSTRACT
Urushinol, a plant allergen, has significantly restricted the medical application of Rhus verniciflua, although it has been reported to possess a wide variety of biological activities such as anti-inflammatory, antioxidant, and anti-cancer actions. To reduce the urushinol content while maintaining the beneficial biological activities, mushroom-mediated fermentation of Rhus verniciflua was carried out and this method resulted in significantly attenuated allergenicity [1]. In the present study, to examine the neuroprotective properties of mushroom-fermented stem bark of Rhus verniciflua, two constituents were isolated from mushroom-fermented bark and their neuroprotective properties were examined in a mouse model of kainic acid (KA)-induced excitotoxicity. KA resulted in significant apoptotic neuronal cell death in the CA3 region of mouse hippocampus. However, seven daily administrations of RVH-1 or RVH-2 prior to KA injection significantly attenuated KA-induced pyramidal neuronal cell death in the CA3 region. Furthermore, pretreatment with RVH-1 and RVH-2 also suppressed KA-induced microglial activation in the mouse hippocampus. The present study demonstrates that RVH-1 and RVH-2 isolated from Rhus verniciflua and detoxified using mushroom species possess neuroprotective properties against KA-induced excitotoxicity. This leads to the possibility that detoxified Rhus verniciflua can be a valuable asset in herbal medicine.
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Animals , Mice , Agaricales , Cell Death , Fermentation , Herbal Medicine , Hippocampus , Kainic Acid , Neurons , Plants , RhusABSTRACT
Histologically, Schmorl's nodes are defined as the loss of nuclear material through the cartilage plate, growth plate, and end plate into the vertebral body. Most Schmorl's nodes are asymptomatic, although there are some reports of symptomatic Schmorl's nodes, which should be treated similarly to vertebral compression fractures, with conservative treatment as the first choice. We report the case that we reduced the pain by blocking the ramus communicans nerve in a patient with Schmorl's node.
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Humans , Cartilage , Fractures, Compression , Growth Plate , Nerve BlockABSTRACT
Spinal myoclonus is an unusual, self-limiting, adverse event that may occur during spinal anesthesia. The exact cause and underlying biochemical mechanism of spinal myoclonus remain unclear. A few cases of spinal myoclonus have been reported after administration of intrathecal bupivacaine. We report a case in which spinal myoclonus recurred after two episodes of spinal anesthesia with bupivacaine at a 1-year interval in a 35-year-old woman. The myoclonus was acute and transient. The patient recovered completely, with no neurologic sequelae.
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Adult , Female , Humans , Anesthesia, Spinal , Bupivacaine , MyoclonusABSTRACT
Various complications of central venous catheterization have been reported, some of which are well-known, while others are described as a sporadic events. We experienced a case of left subclavian venous catheterization complicated by extravascular knotting, kinking, and entrapment of the guidewire and the guidewire was removed surgically. Although minimal resistance was encountered during guidewire insertion, the guidewire was advanced approximately 30 cm. Physicians should be aware of these rare potential complications when a guidewire is advanced if any resistance is encountered.
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Catheterization , Catheterization, Central Venous , Catheters , Central Venous CathetersABSTRACT
OBJECTIVE: This prospective study evaluated the use of continuous sedation using propofol and remifentanil when carpal tunnel release (CTR) was performed under local anesthesia. METHODS: We sedated 60 patients undergoing CTR using local anesthesia with remifentanil at loading and continuous doses of 0.5 microg kg(-1) and 0.05 microg kg(-1)min(-1), respectively, and propofol, using a target controlled infusion (TCI) pump set to a target of 2 microg mL(-1) (group A), or with the same drug doses except that the continuous remifentanil dose was 0.07 microg kg(-1)min(-1) (group B) or 0.1 microg kg-1min-1 (group C). RESULTS: In group B, the levels of pain when local anesthetics were administered (p = 0.001), intraoperative pain (p < 0.001) and anxiety (p = 0.001) were significantly lower than those of group A. Furthermore, the incidence of adverse events, including desaturation (p < 0.001) and vomiting (p = 0.043), was significantly lower in group B than in group C. CONCLUSION: Continuous sedation using an appropriate dose of remifentanil and propofol can be used as safe, efficacious ambulatory anesthesia in cases of CTR under local anesthesia, performed using only 2 mL of local anesthetic, with a high degree of patient satisfaction.
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Humans , Anesthesia , Anesthesia, Local , Anesthetics, Local , Anxiety , Carpal Tunnel Syndrome , Incidence , Patient Satisfaction , Piperidines , Propofol , Prospective Studies , VomitingABSTRACT
This report presents the case of a 63-year-old man who had a myocardial infarction leading to coronary artery bypass graft 2 years earlier who subsequently underwent elective laparoscopic cholecystectomy. After an uneventful operation, the patient developed an acute postoperative myocardial infarction in the recovery room and died 19 days postoperatively. Anesthesiologists should be aware of the rare possibility of acute, fatal postoperative myocardial infarction and consider this complication when they perform the preoperative risk evaluation, anesthesia, and postoperative care for cardiac patients undergoing noncardiac surgery.