RESUMO
We report a case of unexpected difficult intubation in an adult caused by a laryngeal web. A 43-year-old woman with uterine myoma was scheduled for abdominal hysterectomy. After induction of anesthesia, the vocal cords were seen clearly under laryngoscopy. Although intubation was attempted several times, a 6.5 mm internal diameter tracheal tube could not be passed below the level of the vocal cords because of resistance, and we used a laryngeal mask during anesthesia. Next morning after the operation, she developed dyspnea. Bronchoscopy revealed a very narrow airway below the level of vocal cords caused by a laryngeal web. Tracheostomy was performed. Two weeks later, tracheostomy was closed without any sequela.
Assuntos
Cuidados Intraoperatórios , Intubação Intratraqueal , Laringe/anormalidades , Adulto , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/cirurgia , Anestesia Geral , Feminino , Humanos , Máscaras Laríngeas , Leiomioma/cirurgia , Complicações Pós-Operatórias , Traqueostomia , Neoplasias Uterinas/cirurgiaRESUMO
We encountered left recurrent nerve palsy in four patients who had undergone surgery unrelated to the course of the vagus nerve or recurrent nerve, during which they had received endotracheal anesthesia. They were intubated without difficulty and underwent surgery without trouble, but postoperatively they all complained of hoarseness. We used a disposable ENTRASOFT endotracheal tube with high volume, low-pressure cuff in three patients and a disposable PORTEX endotracheal tube with low volume, standard cuff in one patient. In three patients recurrent nerve palsy healed completely within two months after the operation, and one patient was recovering from the palsy on the twentieth day after the operation. We believe that the most plausible explanation of recurrent nerve palsy is the excessive pressure from the inflated endotracheal tube cuff on the intralaryngeal course of the anterior branch of the recurrent nerve. Monitoring cuff pressure is most important to prevent recurrent nerve palsy after endotracheal intubation.
Assuntos
Intubação Intratraqueal/efeitos adversos , Paralisia/etiologia , Nervo Laríngeo Recorrente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/etiologiaRESUMO
We administered argatroban, a selective thrombin inhibitor, as an anti-coagulant during and following vascular surgery. Activated coagulation time was controlled easily by its continuous intravenous infusion. No abnormal bleeding tendency and thrombus formation in graft and blood vessel were observed. The activity of thrombin was inhibited under the infusion of argatroban. We conclude that argatroban is effective for anti-coagulant therapy during and following vascular surgery.
