Challenges with two epidural catheters for labor analgesia in a patient with lumbar adhesions: a case report.

BACKGROUND: The efficacy of neuraxial analgesia varies with spinal canal pathology. Notably, a secondary epidural catheter has been shown to increase neuraxial labor analgesia in women with spinal lesions. Therefore, we present a case in which catheter withdrawal played a critical role in achieving effective labor analgesia in a woman with epidural adhesions after lumbar discectomy who had inadequate analgesia with two epidural catheters. CASE PRESENTATION: We encountered a patient with L5 lumbar epidural adhesions who reported pain even after receiving two epidural catheters. The catheters were placed in the L1/2 and L5/S intervertebral spaces. Analgesic effects were exerted when the L5/S catheter was withdrawn by 1 cm, suggesting that the catheter tip was initially placed inside the adhesion. CONCLUSIONS: Careful consideration of catheter placement and adjustments by withdrawing the catheter are crucial in managing labor analgesia in patients with known epidural adhesions.

Anesthetic management of cesarean hysterectomy using intra-aortic balloon occlusion in a patient with Fontan circulation and placenta increta: a case report.

BACKGROUND: In patients with Fontan circulation, hemorrhage can cause life-threatening circulatory collapse, since Fontan circulation strongly depends on the preload. Furthermore, parturients with placenta accreta spectrum are at a high risk of rapid and massive hemorrhage. Herein, we report the case of an intra-aortic balloon occlusion used for a Fontan-palliated parturient with placenta increta with successful anesthetic management. CASE PRESENTATION: A 35-year-old-female with Fontan circulation diagnosed with placenta increta underwent a cesarean hysterectomy. The main goal during anesthetic management was to maintain sufficient preload. Infrarenal intra-aortic balloon occlusion was used to reduce intraoperative hemorrhage. The hemodynamic changes caused were well tolerated in this case. CONCLUSIONS: Intra-aortic balloon occlusion was used in a Fontan-palliated parturient with placenta increta with successful anesthetic management.

[Airway management in children with vallecular cyst: review of 25 cases--can we predict difficult intubation?].

BACKGROUND: Vallecular cysts frequently cause difficult intubation due to poor glottic visualization during direct laryngoscopy. The appropriate way of airway management and predictive factors of difficult intubation are unknown. METHODS: We reviewed anesthetic induction and airway management in 25 cases of vallecular cysts for the past 11 years. We collected the following data of 24 cases in 20 children who were intubated under direct laryngoscopy: age (month), height (cm), weight (kg), cyst-diameter (mm), cyst-diameter to patient-height ratio, and clinical symptoms. These data were compared between difficult intubation group (group A) and easy or slightly difficult intubation group (group B). RESULTS: In the majority of cases, anesthesia was induced with spontaneous ventilation maintained. Group A and B consisted of 6 and 18 cases, respectively. All cases of group A required assistive devices such as stylets or tube introducers. Cyst-diameter to patient-height ratios were significantly higher in group A than in group B (0.26 vs. 0.18, P = 0.03). CONCLUSIONS: Because children with vallecular cysts have a risk of difficult airway, we need to prepare for difficult airway management. The cyst-diameter to patient-height ratio could be useful as a predictor of difficult intubation.

[The effect of dexmedetomidine in a child with intractable supraventricular tachyarrythmia after total cavopulmonary connection].

We report a case of a 3-year-old boy who had undergone total cavopulmonary connection for repair of corrected transposition of the great arteries (cTGA), and developed intractable supraventricular tachyarrhythmia. The patient was in cardiogenic shock and did not respond to antiarrhythmic drugs and cardioversion, and we used extracorporeal life support (ECLS) to maintain hemodynamics. We used dexmedetomidine to block sympathetic activity. After administration of dexmedetomidine, tachycardia was improved, and the sinus rhythm returned. No recurrence was observed. In conclusion, dexmedetomidine might be useful for intractable supraventricular tachyarrhythmia after pediatric congenital heart surgery.