[Show abstract][Hide abstract] ABSTRACT: We present an emergency anesthetic management of craniotomy for a 22-year-old man with congenital cyanotic heart disease due to brain abscess. Pulmonary blood flow was completely supplied via major arteriopulmonay collatelal artery (MAPCA). This patient complicated with Eisenmenger syndrome, has no history of cardiac surgery but several times of craniotomy due to repeated brain abscess. Total intravenous anesthesia with propofol and remifentanil was induced and maintained. SpO2 and PaO2 were elevated after oxygen administration via mask. Although systemic blood pressure level was decreased by anesthesia and continuous infusion of vasopressors was required. Oxygenation parameters were unchanged. This indicates that blood flow through MAPCA did not respond to changes in of respiratory and circulatory circumstances during anesthesia.
No preview · Article · Feb 2010 · Masui. The Japanese journal of anesthesiology
[Show abstract][Hide abstract] ABSTRACT: This case report describes the difficult respiratory management of an esophageal cancer patient with acute respiratory distress syndrome (ARDS) and systemic inflammatory response syndrome (SIRS) caused by a postoperative tracheogastric roll fistula. A single-lumen tracheal tube could not seal the fistula, and therefore a double-lumen tracheal tube (DLT) for the left side was used. Although the proximal cuff of the DLT failed to seal the fistula, independent lung ventilation (ILV) improved blood gas levels. During right thoracotomy, the left lung was ventilated conventionally with 5 cmH2O positive end-expiratory pressure (PEEP), and in addition, high-frequency oscillation ventilation (HFOV) to the right lung was employed. This combination allowed the maintenance of adequate oxygenation, and the HFOV to the right lung decreased the \(
level during surgery without interruption of the surgical field. These techniques provided the opportunity to successfully remove a necrotic gastric roll and achieve closure of the fistula using an intercostal muscle flap. This report documents and discusses the difficulty of performing appropriate anesthetic management of a patient with these complex complications after esophageal surgery.
No preview · Article · Feb 2008 · Journal of Anesthesia
[Show abstract][Hide abstract] ABSTRACT: A 62-year-old man complicated with old antero-septal wall myocardial infarction and atrial fibrillation suffered from lung and pancreas cancer. He underwent gastro-duodenum bypass surgery under epidural combined with general anesthesia. His ECG and echocardiogram revealed atrial fibrillation and his left ventricular ejection fraction was 35%. After the start of surgery under general anesthesia, EHR was stable between 80-100 beats x min(-1) but rapid atrial fibrillation developed with a rate of over 140 beats x min(-1) after epidural injection of 0.375% ropivacaine 3 ml. Treatment including continuous intravenous diltiazem and several bolus intravenous injections of verapamil failed to decrease the heart rate. Therefore we used landiolol, a short-acting beta blocker, to control heart rate. HR decreased without decreasing his blood pressure. Continuous landiolol infusion was maintained for 3 hours and 30 minutes in the ICU. After finishing infusion, his heart rhythm never became rapid atrial fibrillation. We conclude that landiolol is useful for heart rate control of rapid atrial fibrillation.
No preview · Article · Jun 2004 · Masui. The Japanese journal of anesthesiology
[Show abstract][Hide abstract] ABSTRACT: We report here a patient presenting with long-lasting chronic abdominal pain and constipation that was successfully treated using bilateral splanchnic nerve blocks. Two laparotomies did not reveal the cause the intestinal obstruction and a diagnosis of chronic idiopathic intestinal pseudo-obstruction was made. The splanchnic nerve block is a good option in the treatment of this disease.