Difficult intubation due to interarytenoid adhesion: A case report / 대한마취과학회지

Interarytenoid adhesion of the vocal cords, with a triangular anterior opening and a smaller posterior rounded opening, is one of the complications of intubation. The vocal cords are tethered to each other and they are restricted with narrow abduction, causing difficult intubation. A 57-year-old woman was scheduled to undergo lung wedge resection. The patient had experienced a prolonged intubation 15 years previously. Thereafter, she had undergone two operations and intubation was difficult to perform with using small size endotracheal tubes (6.5 and 6.0 mm inner diameter, respectively). Despite this past medical history, anesthesia was performed without further evaluation because of the patient's refusal. After the failure of an initial trial of intubation with a double lumen endobronchial tube, we tried to intubate with a small sized endotracheal tube (5.0 mm). But it was impossible to pass the tube through the vocal cords. Endobronchial endoscopy revealed interarytenoid adhesion of her vocal cords. After tracheostomy, she received wedge resection. Therefore, the possibility of difficult intubation due to interarytenoid adhesion of the vocal cords should be considered for a patient with a past history of intubation.

Risk Factors of Acute Renal Failure after Colorectal Surgery / 영남의대학술지

BACKGROUND: Acute renal failure is one of the leading causes of postoperative morbidity and mortality. The purpose of this study was to determine the risk factors that are associated with acute renal failure after colorectal surgery. MATERIALS AND METHODS: Five hundred seventy patients who operated colorectal surgery at the Yeungnam University Medical Center over three years from 2004 to 2006 were enrolled in this study. The effects of gender, age, ASA classification, concomitant disease, surgery type and duration, reoperation, urogenital manipulation, medication, hypotension, hypovolemia, transfusion, and postoperative ventilatory care on the occurrence of acute renal failure after colorectal surgery were studied. RESULTS: The major risk factors of acute renal failure after colorectal surgery were age of patients (P=0.003), ASA classification (P<0.001), concomitant disease (P<0.001), duration of the time surgery (P=0.034), reoperation (P=0.001), use of intraoperative diuretics (P=0.005), use of postoperative diuretics (P<0.001), intraoperative hypotension (P=0.018), intraoperative transfusion (P<0.001), postoperative transfusion (P<0.001), and postoperative ventilatory care (P=0.001). CONCLUSION: Multiple factors cause synergistic effects on the development of acute renal failure after colorectal surgery. Therefore, efforts to reduce the risk factors associated with acute renal failure are needed. In addition, intensive postoperative care should be provided to all patients.