Intracavity drainage under local anesthesia for giant emphysematous bulla and infected bulla

We performed a retrospective review of 9 patients who underwent intracavity drainage under local anesthesia for emphysematous bulla and infected bulla between 1996 and 2010. Three patients with giant emphysematous bulla were treated intracavity drainage. Pneumothorax occurred and was treated by chest tube in all cases. Radiographic and symptomatic improvement occurred in all patients. After that, bullectomy was performed safely in 2 patients and intrabullar suction with fibrin glue was performed in 1. There were 6 cases with infected bulla that was not improved by the administration of antibiotics. After intracavity drainage, control of infection was achieved, and all but 1 patient were discharged without drain and complications. Intracavity drainage under local anesthesia is a safe and effective treatment for giant emphysematous bulla and infected bulla.     

Considerations for general anesthesia combined with epidural anesthesia in a patient with stiff-person syndrome

We report the successful management of anesthesia in a patient with stiff-person syndrome (SPS) undergoing a thymectomy using a volatile anesthetic combined with epidural anesthesia. The anesthetic concern in patients with SPS is the possibility of postoperative hypotonia due to the presence of excessive γ-aminobutyric acid (GABA) resulting from an interaction between the anesthetic agents and preoperatively taken therapeutic drugs. Epidural anesthesia has the advantages of decreasing the required amount of anesthetics with GABAergic action, and relieving the postoperative pain that causes the symptoms of SPS. Epidural anesthesia could be a useful technique in SPS patients.     

超声引导下腰丛神经阻滞与骶管阻滞复合全麻在小儿髋关节手术中的比较

目的比较超声引导下腰丛神经阻滞与传统骶管阻滞复合全麻在小儿髋关节手术中的临床应用效果。方法择期行先天性髋关节手术患儿40例,年龄1~6岁,随机分为两组,分别采用超声引导下腰丛神经阻滞(L组)或骶管阻滞(C组)。两组均使用0.2%罗哌卡因1ml/kg。记录术中芬太尼的用量,术后CHEOPS疼痛评分,以及术后首次使用PCA的时间和PCA总量。记录术中低血压、心动过缓的发生率,拔除导尿管的时间以及术后恶心呕吐的发生率。结果 L组首次使用PCA时间明显晚于C组,PCA总量明显低于C组,拔除导尿管的时间明显早于C组(P0.05)。两组在术中芬太尼的用量,术后CHEOPS疼痛评分,术中低血压、心动过缓的发生率,术后恶心呕吐的发生率差异无统计学意义。结论超声引导下腰丛神经阻滞较骶管阻滞在小儿髋关节手术中镇痛时间更久,可安全有效地应用于临床。     

Anesthetic management of a patient with severe combined pulmonary disease under epidural anesthesia with spontaneous respiration

A 74-year-old man with gastric cancer was complicated with abdominal aortic aneurysm. A two-stage operation was scheduled (repair of abdominal aortic aneurysm and subsequent gastrectomy). He also had severe chronic obstructive pulmonary disease (COPD). We planned to maintain spontaneous breathing during operations under epidural anesthesia and light general anesthesia. For the first surgery, two epidural catheters were placed at T1-2 and T7-8 on the day before surgery. After establishing epidural anesthesia, general anesthesia was induced and maintained with midazolam, fentanyl and sevoflurane, but without muscle relaxants under BIS monitoring. Ropivacaine solution 0.375% was infused through an epidural catheter to provide analgesia, and spontaneous breathing was kept throughout the procedure. Surgery lasted 4 hours and 50 minutes, and patient recovered without complications. Forty days after the first surgery, the second operation was scheduled. Anesthetic management was almost the same as in the first one, except for the use of dexmedetomizine rather than sevoflurane. In both operations, sufficient analgesia was provided with epidural anesthesia, and the surgeons rated muscle relaxation as satisfactory. No respiratory complications developed postoperatively. Maintaining spontaneous breathing during abdominal surgery using epidural anesthesia and light general anesthesia is a good option for COPD patients.     

An unusual bulla in azygoesophageal recess in a patient with secondary spontaneous pneumothorax

We report a case of secondary spontaneous pneumothorax in which the causative bulla was successfully managed by thoracoscopic surgery. A 64-year-old male was admitted presenting with a right pneumothorax. Chest computed tomography revealed a bulla located in the azygoesophageal recess. Thoracoscopic surgery confirmed an unusual bulla extending along the thoracic spine with a fistula at the tip. We describe the intriguing features of this unique bulla and speculate on its aetiology for the first time.     

Case of general anesthesia combined with epidural anesthesia in a pregnant woman undergoing thoracotomy for spontaneous pneumothorax

General anesthesia combined with epidural anesthesia for thoracotomy due to spontaneous pneumothorax was given to a pregnant woman at 21st week of gestation. She was premedicated intravenously with famotidine 20 mg and metoclopramide 10 mg. Mepivacaine 1% was administered through a thoracic epidural catheter. General anesthesia was induced by thiamylal 225 mg, vecuronium 8 mg and fentanyl 100 mcg, and maintained by sevoflurane, vecuronium and fentanyl. Endobronchial intubation with a 35Fr Bronchocath double-lumen tube was successful and one-lung ventilation was commenced to maintain the end-expiratory CO2 pressure at 30 to 35 mmHg with Sp(O2) remaining 100%. Ephedrine 16mg (in 4mg increments) was required to maintain systolic blood pressure above 100 mmHg. After the surgery, ropivacaine 0.2% was administered through the catheter. There were no clinical signs of fetal distress during the perioperative period. Postoperative pregnancy and delivery were uneventful. We succeeded in the anesthetic management by avoiding hypoxia, hypercapnia, hypocapnia and hypotension during the surgery.     

硬膜外阻滞复合全麻对于后腹腔镜手术术中应激反应的影响

目的 比较硬膜外阻滞复合全麻(GEA)和全麻(GA)对后腹腔镜下手术术中应激反应的影响.方法 40例后腹腔镜下泌尿外科手术患者随机均分为GE组和GA组,均行异氟醚静吸复合全麻.GE组全麻诱导前行1.5%利多卡因加0.2%布比卡因硬膜外阻滞,麻醉平面维持在T4左右.分别于入室镇静后(T0)、气腹前(T1)、气腹后30 min(T2)、60 min(T3)、拔管后10 min(T5)记录MAP、HR的变化,并测定血浆内皮素(ET)、降钙素基因相关肽(CGRP)浓度,记录异氟醚的吸入浓度.结果 T1～T3时,GE组MAP明显低于T0时,且明显低于GA组(P<0.05).T5时两组HR均明显快于T0时(P<0.05).T2、T3、T5时GE组ET、CGRP明显低于GA组(P<0.05).T2、T3时GA组ET明显高于T0时(P<0.05).T3时GA组CGRP明显高于T0时(P<0.05).T1～T4时GE组异氟醚MAC值显著低于GA组(P<0.05),T2～T3时两组MAC值均显著高于T1时,T4时显著低于T1时(P<0.05).结论 与GA比较,GEA可以有效地减轻后腹腔镜下泌尿外科手术患者术中的应激反应.     

Stroke following appendectomy under general anesthesia in a patient with basilar impression

We report a boy who developed a vertebral stroke immediately after an appendectomy. Basilar impression was diagnosed eight years after this event when skull roentgenograms revealed basilar impression with high standing tip of the odontoid. We speculate that muscle relaxation and cervical hyperextension during intubation in the presence of basilar impression resulted in vertebral artery dissection and stroke. We suggest that patients with vertebral stroke and no obvious risk factors should be evaluated for the presence of malformations of the craniovertebral junction to be able to take precautions against excessive neck movement during intubation.     

Arthroscopic shoulder surgery under general anesthesia with brachial plexus block

Objective

Changes in respiratory parameters and pulmonary function tests were evaluated after shoulder arthroscopic surgery with brachial plexus block (BPB). The purpose of this study was to identify the mechanism of respiratory dysfunction after this type of surgery.

Methods

Patients undergoing arthroscopic rotator cuff repair under general anesthesia (GA) with BPB were enrolled in the arthroscopy group (n?=?30) while those undergoing open reduction of a clavicle or humerus fracture under GA were enrolled in the control group (n?=?30). Forced vital capacity (FVC) and forced expiratory volume 1 s (FEV₁) were measured at the outpatient clinic stage (#1) before (#2) and 20 min after BPB (#3) and 1 h after extubation (#4). Respiratory variable measurements along with the cuff leak test were performed 5 min after surgical positioning (T1) and at the start of skin closure (T2). Respiratory discomfort was evaluated after extubation. The upper airway diameters and soft tissue depth of chest wall were also measured by ultrasonography at stages #3 and #4.

Results

Static compliance decreased significantly at T2 in the arthroscopy group (50?±?11 at T1 vs. 44?±?9 ml/cm H₂O at T2, p?=0.035) but not in the control group. The incidence of positive cuff leak tests at T2 was significantly higher in the arthroscopy group than in the control group (47% in the arthroscopy group vs. 17% in controls, p?=0.010). While FEV₁ and FVC remained stable at stages #1 and #2, FVC and FEV₁ decreased at stages #3 and #4 only in the arthroscopy group (FVC in arthroscopy group, #2: 3.26?±?0.77 l; #3: 2.55?±?0.63 l, p?=0.015 vs. #2; #4: 2.66?±?0.41 l, p?=0.040 vs. #2). The subglottic diameter decreased at #4 in the arthroscopy group, while no changes occurred in the control group (0.70?±?0.21 cm vs. 0.85?±?0.23 cm in the arthroscopy and control groups, respectively, p?=0.011). Depth of skin to pleura increased at both intercostal spaces 1–2 and 3–4 in the arthroscopy group. There were three cases of hypoxia (S_pO₂?<?95%) with room air in the arthroscopy group while none occurred in the controls.

Conclusion

Shoulder arthroscopic surgery under GA with BPB induced both restrictive and obstructive pathologies. It is important to maintain a high level of awareness for the potential negative respiratory effects of this surgery especially for subjects with pre-existing cardiopulmonary disease. The measurements in this study would be useful to monitor the risk of respiratory dysfunction in these patients.     

球后神经阻滞联合全身麻醉在角膜移植术中的应用研究

目的  探讨球后神经阻滞联合全身麻醉（全麻）在穿透性角膜移植术（PKP）中的应用价值。方法  研究对象选择2017年1月至2019年1月期间行PKP的100例受者。采用随机数字表法将受者分为观察组50例）与对照组（50例）。对照组行喉罩通气全麻术;观察组行喉罩通气全麻术联合球后神经阻滞技术。观察两组PKP受者手术前后血流动力学改变、术中镇痛剂使用量以及并发症的发生情况,采用视觉模拟评分法（VAS）评估两组受者术后2、6、24 h疼痛程度,观察两组受者的苏醒情况。比较两组受者术前1 d及术后1 d的炎症因子水平。结果  观察组在术中15 min、手术结束时的平均动脉压、心率明显高于对照组（均为P < 0.05）。观察组受者术中瑞芬太尼和丙泊酚的使用量分别为（1.0±0.4）、（299±40）mg,明显低于对照组受者的（1.3±0.6）、（365±42）mg（均为P < 0.05）。两组并发症发生率的比较均无统计学意义（均为P > 0.05）。观察组受者在术后2、6、12 h的VAS评分均低于对照组受者（均为P < 0.01）。观察组受者呼吸恢复、呼之睁眼、定向力恢复及拔管时间均短于对照组受者（均为P < 0.05）。观察组受者术后1 d的白介素（IL）-1、IL-6及肿瘤坏死因子（TNF）-α水平均低于对照组受者（均为P < 0.05）。结论  球后神经阻滞联合全麻可以维持PKP术中血流动力学稳定,降低瑞芬太尼与丙泊酚使用量,减轻受者术后疼痛程度以及炎症反应。     

全麻复合硬膜外麻醉对老年腹腔镜直肠癌手术患者应激反应的影响

目的 探讨全麻复合硬膜外麻醉对老年腹腔镜直肠癌手术患者应激反应的影响.方法 选择我院行腹腔镜直肠癌根治术患者64例,随机分为对照组及研究组,对照组采用气管插管全麻,研究组采用气管插管全麻复合硬膜外麻醉,比较两组患者手术前、麻醉复苏前及术后第1天血糖水平（BS）、胰岛素抵抗指数（1R）以及血清皮质醇（Cor）、肾上腺素（AD）浓度的变化.结果 手术前两组患者BS、IR、Cor及AD水平无显著差异（P＞0.05）,麻醉复苏前研究组BS、IR、Cor及AD水平高于对照组（P＜0.05）,术后1天研究组BS、IR、Cor及AD水平高于对照组（P＜0.05）.结论 全麻复合硬膜外麻醉能够减轻老年腹腔镜直肠癌根治患者应激反应,有利于减少手术创伤,增加手术及麻醉安全.     

Interscalene brachial plexus block for shoulder surgery in a patient with arthrogryposis multiplex congenita

A five-year-old child with severe arthrogryposis multiplex congenita and malnutrition underwent surgery for chronic osteomyelitis of the head of the left humerus. The child had typical features of arthrogryposis multiplex congenita, including a difficult airway. Propofol was used for induction and maintenance. Spontaneous respiration was maintained with a nasal airway. Analgesia was provided with an interscalene brachial plexus block placed using a nerve stimulator. No opioid was given. The child had an uneventful recovery with good postoperative analgesia. The anaesthetic implications of arthrogryposis multiplex congenita are discussed.     

Experience in diagnostic-therapeutic broncho-fibroscopy with children under combined general anesthesia

An alternative method of bronchoscopy conduction under combined general anesthesia without artificial pulmonary ventilation usage was elaborated and substantiated in the patients ageing from 3 mo to 15 yrs old. In 40 patients, using rigid bronchoscope, it was possible to look over down to the order I bronchi only. There was observed the striated body muscles fibrillation after injection of myorelaxants and in 13 (86.7%) of patients--excoriation of oral pharynx and trachea mucosa. While waking up of the patients characteristic bronchospastic disorder of respiration was noted. In 40 patients, while applying bronchofibroscopy, the examination of bronchi down to their order III was possible. Usage of the diagnostic method proposed had promoted reduction of possibility of iatrogenic complications occurrence.     

A patient with Shy-Drager syndrome managed under general anesthesia with thoracic epidural anesthesia

A 61-year-old man with Shy-Drager Syndrome underwent partial pulmonary lobectomy under general anesthesia combined with thoracic epidural anesthesia. The blood pressure decreased from 140/ 100 mmHg to 80/50 mmHg after thoracic epidural anesthesia. It increased after intravenous ephedrine. The blood pressure decreased when he was returned to the supine position postoperatively. It did not increase as expected with intravenous ephedrine. Intravenous etilefrine promptly raised the blood pressure. There was no postoperative cardiorespiratory complications.     

Caudal anesthesia combined with general anesthesia in comparison with general anesthesia in ambulatory circumcision

In 100 boys (5.9 +/- 3.2 years old) undergoing outpatient circumcision, analgesia was provided with 0.375% bupivacaine 1 ml/year of age by caudal injection (group I), administered after induction of general anesthesia. This group was compared with 100 boys (6.3 +/- 3.4 years old), who received only general anesthesia (group II). The puncture technique described was free of complications and the caudal blocks were 98% successful. There was a great difference with regard to the levels of general anesthesia: the average enflurane concentrations required to block autonomic reactions during surgical intervention was 1.3 vol% in group I and 2.7 vol% in group II. The amount of pethidine needed for perioperative pain relief was 8 mg (+/- 5.7) in 17/100 of group I and 17.3 mg (+/- 6.8) in 91/100 of group II. In addition, paracetamol was given in 10/100 of group I and 30/100 of group II. The boys in group I showed calm postoperative behavior. In both groups there were only slight differences in hemodynamic parameters. Of the parents who answered our questionnaire (50 answers to 60 questionnaires), 68% were amazed at the duration of analgesia. During the late postoperative period, in group I there was an almost total absence of vomiting (4%), with an associated rapid return to normal feeding. In 83% the effect of late postoperative analgesia worked so well that no subsequent analgesic was given. In 15% the pain relief lasted 6.3 +/- 2.5 h. The excellent postoperative pain relief produced by caudal anesthesia justifies its frequent use for children subjected to genital surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Anaesthesia for the patient with a coincidental giant lung bulla: A case report

The anaesthetic management of a patient with a coincidental giant lung bulla who underwent lumbar discectomy and laminectomy is described. The specific problems associated with anaesthesia in patients with bullae, such as acute enlargement or rupture of the bullae, are discussed. Precautionary measures which may be taken during anaesthesia include the avoidance of nitrous oxide, the prophylactic use of a double-lumen tube, and the immediate availability of chest drains in the anaesthetizing area. Monitoring during operation may involve bilateral chest auscultation and arterial blood gas analysis.