[Show abstract][Hide abstract] ABSTRACT: Airway changes generally occur in normal gravidas; however, these changes could cause critical situations in specific populations.
This article presents the case of a difficult airway patient that went into shock because of atonic bleeding after vaginal delivery for stillbirth.
A 32-yr-old woman with atonic bleeding after vaginal delivery for stillbirth was transferred to our hospital. She manifested shock, and her respiratory condition was progressively deteriorating. Airway obstruction caused by neck swelling and pharyngolaryngeal edema was apparent. We tried tracheal intubation using direct and indirect laryngoscopes. However, it turned out that insertion of the laryngoscopic devices to the oral cavity was impossible. After several attempts using the Trachlight™, successful intubation was finally made. After hysterectomy, she was admitted to the intensive care unit (ICU) and treated for five days. At discharge from the ICU, her Mallampati score was I-II. Her body weight decreased 60kg to 51kg during ICU stay.
We believe that concomitant attacks of labor and delivery and fluid resuscitation probably worsened upper airway and neck edema enough to cause acute airway obstruction and difficult laryngoscopy.
[Show abstract][Hide abstract] ABSTRACT: Experiência e objetivos
Em geral, alterações nas vias aéreas ocorrem em grávidas normais; no entanto, essas alterações podem gerar situações críticas em populações específicas.
Esse artigo apresenta o caso de uma paciente que entrou em choque por causa de sangramento atônico em seguida a parto vaginal de natimorto.
Relato de caso
Mulher com 32 anos com sangramento atônico em seguida a parto vaginal de natimorto foi transferida para nosso hospital. A paciente manifestou choque e seu estado respiratório estava em progressiva deterioração. Ficou evidenciada obstrução das vias aéreas causada por inchaço cervical e edema faringolaríngeo. Tentamos intubação traqueal utilizando laringoscopia direta e indireta. No entanto, não foi possível inserir qualquer dos dispositivos de laringoscopia tentados. Depois de várias tentativas com Trachlight™, finalmente obtivemos sucesso com a intubação. Depois da histerectomia, a paciente foi internada na unidade de terapia intensiva (UTI), onde ficou em tratamento durante cinco dias. Ao receber alta da UTI, tinha escore de Mallampati I-II. Durante sua estadia na UTI, seu peso diminuiu de 60 kg para 51 kg.
É provável que episódios simultâneos de trabalho de parto/parto e de ressuscitação com fluidos pioraram suficientemente o edema de via aérea e o inchaço cervical a ponto de causar obstrução aguda das vias aéreas e dificuldade na laringoscopia.
Revista Brasileira de Anestesiologia 11/2013; 63(6):508–510. DOI:10.1016/j.bjan.2012.09.004 · 0.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: De manera general, las alteraciones en las vías aéreas se dan en las embrazadas normales; sin embargo, esas alteraciones pueden generan situaciones críticas en poblaciones específicas.
[Show abstract][Hide abstract] ABSTRACT: We report two cases in which development of laryngospasm and release of the spasm immediately after applying pressure in the "laryngospasm notch" was confirmed by ultrasonographic and fiberoptic examinations. A bronchoscopy was planned under propofol sedation using a laryngeal mask airway for a 61-year-old man after subtotal esophagotomy. When a bronchoscope was advanced into the trachea, the vocal cords suddenly closed. Immediately after pressure with the fingertips was applied to the "laryngospasm notch," the vocal cords opened, which was observed through the bronchoscope in real time. A 22-year-old woman presented for emergency caesarean section under general anesthesia. After the completion of the procedures, the patient was not yet following commands but her breathing was steady. Thus, extubation was performed; however, she began to display signs of respiratory stridor. An ultrasonographic examination revealed that the vocal cords were noted to close, which suggested that she was developing laryngospasm. With this diagnosis, pressure at the "laryngospasm notch" was applied. Immediately after this maneuver, the vocal cords opened. We reconfirmed that applying pressure in the "laryngospasm notch" was effective to release laryngospasm. Imaging studies, especially ultrasonographic examination, were useful for making the decision to apply pressure in the "laryngospasm notch."
Journal of Anesthesia 03/2013; 27(5). DOI:10.1007/s00540-013-1592-x · 1.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Stroke remains a major perioperative problem for anesthesiologists. In this article, we have described preoperative evaluation and prognosis of patients with cerebrovascular disease. Cerebral infarction accounts for more than 60% of stroke. In patients with recently developed ischemic stroke, a surgery should be delayed at least for a month. Carotid artery stenosis accounts for 15 to 20% of ischemic stroke. In these patients, since the incidence of cardiovascular disease is common, cardiovascular examinations may be required preoperatively. The efficacy of carotid endarterectomy (CEA) to prevent stroke is well established, whereas carotid artery stenting (CAS) has been increasingly advocated as less invasive treatment. Several studies have indicated that the risks of CAS are higher than those of CEA, suggesting that CAS may not be used in good surgical candidates. In the patients with subarachnoid hemorrhage (SAH), preoperative assessments of cardiac and respiratory condition are required. It is reported that unfavorable outcome after SAH is related to rebleeding and cerebral vasospasm.
Masui. The Japanese journal of anesthesiology 07/2010; 59(7):862-4.
[Show abstract][Hide abstract] ABSTRACT: A 16-year-old male underwent transcatheter arterial embolization against a large hepatic tumor, and was subsequently scheduled for removal of the tumor. Sudden hypotension and tachycardia were observed on removal of the tumor. Massive bleeding or obstruction of the inferior vena cava was expected to develop, but this did not occur because of simultaneous pulmonary hypertension (PH). The development of acute PH due to pulmonary vasoconstriction was suspected. Milrinone and prostaglandin E1 were effective. The same type of PH was again observed during manipulation of the residual portion of the liver. The acute PH was reproducible each time the liver was manipulated, which could suggest that this series of PH was specifically related to the hepatic lesion. A necrotic hepatic lesion might play an important role in disturbing the pulmonary circulation and causing the development of acute PH.
Journal of Anesthesia 02/2007; 21(4):513-5. DOI:10.1007/s00540-007-0561-7 · 1.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Many complications after spinal anesthesia have been reported, but diplopia is rare. We had four cases of diplopia in 794 cases of spinal anesthesia in three years at Nara Medical University Hospital. These 4 cases were not characterized by any major factors including gender, age, or anesthetic choice. However, two of them were accompanied with post-spinal headache. Diplopia in three cases improved spontaneously, but one finally required epidural blood patch for the persistent diplopia. Lack of concern regarding the possibility of post-spinal diplopia among medical staffs might be common because this incidence is really rare. However, we need to know the possibility of this neurological sequel after spinal anesthesia. We would like to propose that the informed consent regarding spinal anesthesia should include the possibility of this complication and anesthesiologists should perform intensive neurological examinations after spinal anesthesia concerning post-spinal diplopia.
Masui. The Japanese journal of anesthesiology 08/2005; 54(7):767-71.
[Show abstract][Hide abstract] ABSTRACT: To clarify the present state of local institutional guideline for perioperative deep thrombosis and pulmonary embolism in individual hospitals, a questionnaire was sent to anesthesia departments in Japan. According to the replies, 82 hospitals have original guidelines. Forty of them reported the contents of their guidelines. However, 37 hospitals have some problems regarding their guidelines. Cost for these perioperative managements and application of spinal or epidural anesthesia for heparinized patients appears to be commonly recognized as pending questions in their guideline. It seems to be difficult to make a stereotyped standard guideline in Japan because each local guideline has a specific strategy according to their situations. However, it is needless to say that a further nationwide survey and collaboration, and governmental support for these diseases would be required.
Masui. The Japanese journal of anesthesiology 07/2004; 53(6):701-6.