[A case of conversion disorder (hysteria) after spinal anesthesia].

We report a case of conversion disorder after spinal anesthesia. A 16-year-old healthy woman underwent arthroscopic surgery under spinal anesthesia. She showed tremor all over and it did not stop. We sedated her with propofol during the operation. After the operation, her involuntary tremble continued. We consulted with a pediatrician who diagnosed her as conversion disorder. Magnetic resonance imaging and computed tomography were performed to rule out some pathological changes and abnormality in her head. As a result, Rathke cleft cyst was suspected but it could not explain this episode. We consider that her stress for the operation under spinal anesthesia caused this episode. In a case of a younger patient, it is necessary to consider mental support. And we need to suspect conversion disorder when we see tremor during operation under regional anesthesia.

[Questionnaire survey about an anesthesia information sheet].

BACKGROUND: The anesthesia information sheet used in our hospital describes the anesthetic management and complications in a simple style. Patients scheduled for operations receive it from their doctor with some explanation about anesthesia. The written informed consent on the sheet is obtained from the patients. METHODS: One hundred and one patients undergoing elective operations were interviewed after receiving explanations during the anesthesiologist's preoperative rounds. RESULTS: From this survey, 85% of the patients read it before the anesthesiologist's preoperative rounds and 75% of them understood the contents. After the anesthesiologist's explanation, 94% of the patients who had read it understood enough. About a third of the patients who had read the information sheet had anxiety about anesthesia. After the anesthesiologist's explanation, the percentage of patients who had anxiety decreased to 8%. 98% of the patients who read the information sheet answered that it should be read before the anesthesiologist's preoperative rounds. CONCLUSIONS: In view of this survey we concluded that reading the information sheet before the anesthesiologist's preoperative rounds is useful to increase the patients understanding of anesthesia.

[Successful airway management using a Cook airway exchange catheter as an emergent dilator for life-threatening neoplastic stenosis of the trachea: a case report].

A 68-year-old male patient was referred to our hospital for his intractable and progressive dyspnea. Chest roentgenography and computerized tomography revealed severe lower tracheal stenosis due to neoplastic invasion. The tumor completely surrounded his trachea for 5 cm length and the remaining internal diameter of the trachea was less than 5 mm. To avoid fatal asphyxia, emergency airway security was required. After placing both femoral arterial and venous cannulae for percutaneous cardiopulmonary support system, we dilated the stenotic trachea using a Cook airway exchange catheter (CAEC), and then an armored tube of 7 mm inner diameter was introduced through the CAEC. The maneuver was smoothly completed within one minute without any complications. His dyspnea was completely relieved. Following chemotherapy and radiotherapy were so effective that the endotracheal tube was extubated two weeks later uneventfully. After several series of chemotherapy and 50 Gy irradiation, the patient was discharged three months later without symptoms. We concluded that CAEC could be one of the life-saving instruments for emergent airway management in case of severe organic tracheal stenosis.