Fetal surgery and general anesthesia: a case report and review

Fetal surgery, in utero, is now a viable option for some congenital conditions due to recent advances in ultrasound and microsurgical technology. Previous reports of anesthesia for such procedures have focused on spinal or epidural conduction techniques. General endotracheal anesthesia may have several advantages in this setting. In addition to maternal anesthesia, general anesthesia can provide fetal neuromuscular block (without direct fetal injection of blocking agents) and uterine relaxation. It may also blunt fetal response to surgical stimulation.     

Paraplegia after combined general and epidural anesthesia: a case report

Neurological complications after epidural anesthesia performed for abdominal surgery are uncommon, but of important consequence with significant morbidity. Paraplegia is very rare and may be a result of multiple factors. We report a case of elective colectomy under combined general and epidural anesthesia for a carcinoma. An epidural infusion was used for intra-operative and post-operative analgesia. During induction of anesthesia, the patient was asystolic for a few seconds and during the first postoperative day, a hypotensive episode was registered. He then developed a sensory-motor deficit in the legs. A spinal cord infarction at the level of T10 extending to T2 was diagnosed with magnetic resonance imaging. The association of hypotension as a cause of spinal cord infarction is discussed. The factors that may have contributed to paraplegia and preventive neuroprotective strategies are reviewed.     

Awareness during general anesthesia for head and neck surgery--a case report

We report a second case of awareness during general anesthesia with sevoflurane supplemented with fentanyl. A 58-year-old man, weighing 61 kg, underwent an 8.8-hour operation for a malignant tumor of the right mandible. His right eye was guarded with ointment but kept open for observation of facial movement following muscle stimulation by the surgeon. The intraoperative course and emergence from anesthesia were otherwise uneventful. The patient became agitated in the recovery room and could recall his visual memory during the operation. We speculated contribution of visual input through the open eye and/or the effects of cranial bone oscillation during the surgery to his intraoperative awareness.     

Percutaneous trigeminal rhizotomy and percutaneous cordotomy under general anesthesia.

Most percutaneous procedures for the treatment of pain are done under local anesthesia and considerable pain can be involved. If the patient is elderly or confused because of severe pain, it is difficult or impossible to perform these procedures successfully. We treated 3 elderly patients with trigeminal neuralgia and 1 patient with severe bone pain due to metastatic osteosarcoma in the lumbosacral region by percutaneous trigeminal rhizotomy and percutaneous cordotomy under general anesthesia with intratracheal intubation. We conclude that percutaneous trigeminal rhizotomy and percutaneous cordotomy can be safely done under general anesthesia.     

全身麻醉后持续性声音嘶哑1例病例报告及临床分析

全身麻醉后声音嘶哑（声嘶）是围手术期相关并发症之一,一旦发生将严重影响患者生活质量并易引起医疗纠纷。其主要病因为喉返神经麻痹和环杓关节脱位,因两者治疗方法截然不同需重视鉴别诊断,提倡早期诊断,尽早治疗。现报道1例ASA分级Ⅱ级的女性患者,气管内全身麻醉后出现右侧声带麻痹、左侧环杓关节脱位,主要表现为咽痛、持续严重声嘶,因多方原因导致患者延误诊治,积极治疗3月后恢复。临床医师需提高对该疾病的认识和诊治能力。     

Arthroscopic-assisted fixation of Hoffa fracture: A case report and description of technique

Medial condyle Hoffa fractures are intra articular injuries, which require prompt anatomical reduction and internal fixation. Arthroscopy-guided fixation of these fractures has also been advocated; the advantages include avoidance of soft tissue dissection, fast recovery and mobilization. We describe a case of a 28-year-old male patient presenting with a 10-day-old medial condylar Hoffa fracture. Skin condition prevented from conventional open reduction and internal fixation; hence, taking note of the urgency of fixation of an intraarticular fracture, arthroscopic-assisted minimally invasive approach was performed with good outcome.     

Single-incision robotic-assisted living donor nephrectomy: case report and description of surgical technique

The introduction of laparoscopic surgery, and more recently of robotics, has increased the number of living donor kidney transplants. This approach has already improved living donor acceptance rates. Even newer developments in the field have now been introduced with the purpose of further reducing postoperative pain and length of hospital stay, while offering better cosmetic results. In particular, single-incision surgery has gained popularity by improving the well-known benefits of minimally invasive surgery. In this case report, we present the first single-incision robotic-assisted living donor nephrectomy.     

Combined general and epidural anesthesia for a child with alagille syndrome: a case report

Alagille syndrome (syndromic paucity of interlobular bile ducts) is the most common form of familial intrahepatic cholestasis. We describe the perioperative management of a pediatric patient with Alagille syndrome undergoing ileal exclusion and the specific issues associated with epidural anesthesia with this syndrome.     

Sudden cardiac arrest after induction of general anesthesia: a case report

We experienced sudden cardiac arrest after induction of general anesthesia using isoflurane. The patient had had paroxysmal atrial fibrillation for one year and had been treated with digoxin and cibenzoline succinate. Sinus rhythm appeared soon after the start of closed chest compression. However cardiac arrest recurred, and we inserted a temporary pacemaker catheter to stabilize the circulatory status. She awoke from anesthesia without any complications. The diagnosis of sick sinus syndrome (SSS) was made postoperatively and she had a permanent pacemaker implanted. We thought that the hidden SSS had been the cause of this sudden cardiac arrest.     

Arthroscopically assisted percutaneous quadricepsplasty: a case report and description of a new technique

Restricted motion of the knee occurs frequently after an intra- articular fracture of the distal femur. Treatment of this complication typically requires open release of the quadriceps muscle. To our knowledge an arthroscopically assisted method of performing a quadricepsplasty has not been previously described. We present such a case and the details of the arthroscopically assisted method that may provide an alternative, minimally invasive means of restoring knee flexion in the setting of a post-traumatic extension contracture.Arthroscopy 1998 Mar;14(2):212-4     

Thoracic epidural anesthesia combined with general anesthesia: the preferred anesthetic technique for thoracic surgery

Thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) as well as total-IV anesthesia (TIVA) are both established anesthetic managements for thoracic surgery. We compared them with respect to hypoxic pulmonary vasoconstriction, shunt fraction and oxygenation during one-lung ventilation. Fifty patients, ASA physical status II-III undergoing pulmonary resection were randomly allocated to two groups. In the TIVA group, anesthesia was maintained with propofol and fentanyl. In the TEA group, anesthesia was maintained with TEA (bupivacaine 0.5%) combined with low-dose concentration 0.3-0.5 vol% of isoflurane (end-tidal). Changing from two-lung ventilation to one-lung ventilation caused a significant increase in cardiac output (CO) in the TIVA group, whereas no change was observed in the TEA group. One-lung ventilation caused significant increases in shunt fraction in both groups which was associated per definition with a significant decrease in PaO(2) in both groups but PaO(2) remained significantly increased in the TEA group (P < 0.05). We conclude that both anesthetic regimens are safe intraoperatively. However, TEA in combination with GA did not impair arterial oxygenation to the same extent as TIVA, which might be a result of the changes in CO. Therefore, patients with preexisting cardiopulmonary disease and impaired oxygenation before one-lung ventilation might benefit from TEA combined with GA. IMPLICATIONS: Fifty patients underwent lung surgery through the opened chest wall requiring ventilation of only one lung. Patients were randomly assigned to receive either general anesthesia alone or in combination with regional anesthesia via a catheter in the back. Oxygen content in the blood and blood pressure was better maintained in the group receiving the combination of general with regional anesthesia.