[Myoclonus following spinal and epidural anesthesia--a case report].

We report a case of spinal myoclonus following cesarean section. The patient was a 34-year-old woman without history of neurologic disorders. In the operating room, after placement of an epidural catheter at T12-L1, bupivacaine 2.4 ml was administered intrathecally via a 25 G needle at L2-3. Epidural administration of ropivacaine (0.13%, 4 ml x hr(-1)) was started 72 min after spinal anesthesia. The intra- and postoperative courses were otherwise uneventful. The patient complained of involuntary jerky movements of her lower legs 195 min after the start of the spinal anesthesia. The sensory level was T12 and she could move her legs on command but could not stop her involuntary movements. The myoclonic movements ceased 150 min later without medication and did not reappear, despite restarting the epidural anesthesia with ropivacaine.

[Airway management in tracheal stenosis caused by malignant goiter].

We report a case of malignant goiter with severe tracheal stenosis. The patient was a 61-year-old female, who had orthopnea on admission. Radiological examinations revealed a tracheal stenosis extending from 4.5 cm to 8 cm below the glottis; the smallest caliber being 5 mm. On the seventh day after admission, the patient complained of dyspnea even while sitting. An emergency tracheotomy was scheduled. While the patient was awake in a sitting position, a fiberscope was inserted endotracheally to confirm the intact inner surface of the trachea, and then an armored endotracheal tube (outer diameter 9.2 mm, inner diameter 6.5 mm) was inserted. Unexpectedly, the tube could be advanced through the stenosis without resistance. After induction of general anesthesia, the patient was placed in a supine position, and a tracheotomy was performed. This case demonstrates that, while intubation of the trachea through a stenosis is sometimes dangerous, it may be indicated when the inner surface of the trachea is intact and a tube with an inner diameter greater than 5 mm can then be placed.