[Surgery without blood transfusion for pheocromocytoma in a Jehovah's Witness patient: a case report].

A 59-year-old woman who identified as a Jehovah's Witness was diagnosed with pheochromocytoma in the left adrenal gland, measuring 11 cm in diameter, during treatment for hypertension. Given her desire to undergo transfusion-less surgery for religious reasons, we obtained fully informed consent and had the patient sign both a transfusion refusal and exemption-from-responsibility certificate and received consent to instead use plasma derivatives, preoperative diluted autologous transfusion and intraoperative salvaged autologous transfusion. To manage anemia and maintain total blood volume, we preoperatively administered erythropoiesis-stimulating agents and alpha 1 blocker, respectively. During the left adrenalectomy, the patient underwent a transfusion of 400 mL of preoperative diluted autologous blood, ultimately receiving no intraoperative salvaged autologous blood. The operation took 4 hours 42 minutes, and the total volume of blood lost was 335 mL. In conclusion, to complete transfusion-less surgery for pheochromocytoma, it is necessary to have the patient sign a generic refusal form for transfusion and exemption-from-responsibility certificate as well as outline via another consent form exactly what sort of transfusion is permitted on a more specific basis. And doctors should become skilled in perioperative management and operative technique for pheochromocytoma and make the best effort by all alternative medical treatment in order to build trust confidence with a patient.

[Difficult airway management in a man with large pharyngeal tumor].

A 58-year-old man (height 164 cm, weight 64 kg) complained of hoarseness one week prior to admission, and breathing difficulty from the previous day. From endoscopic observation, a pedunculated mass below the glottus was oscillating when breathing. Laryngomicrosurgery and tracheotomy were scheduled to remove the pharyngeal tumor. After oxygenation, continuous propofol infusion was carried out. Because mask or LMA ventilation was not possible, a cricothyroid membrane incision kit was inserted and the airway was secured. Laryngomicrosurgery was then performed and after the tumor resections, LMA was inserted and tracheotomy was carried out. In retrospect, a better alternative method would have been to use the cricothyroid membrane incision kit under local anesthesia for airway management.