Summary Acute pancreatitis is a rare and serious complication during pregnancy. Emergency caesarean section for a patient with acute pancreatitis is challenging for anaesthetists, as it is difficult to relieve both pain associated with pancreatitis and that from a caesarean section operation. Intrathecal high dose morphine is an attractive solution because it provides prolonged analgesia. However, the use of high dose intrathecal opioids remains contentious due to the fear of possible associated respiratory depression. We performed an emergency caesarean section in a patient with severe acute pancreatitis that was successfully managed with high dose intrathecal morphine.
Abstract Background Carbon dioxide embolism is a life-threatening complication of laparoscopic hepatectomy. Case presentation A 59-year-old man was admitted for laparoscopic hepatectomy. Approximately 5 h after commencing the operation, we observed a gradual decline in the SpO 2 from 100 to 94%, reduction in the ETCO 2 from 44 to 19 mmHg, reduction in the systolic blood pressure from 100 to 82 mmHg, and elevation of the heart rate from 82 to 120 beats/min. Intraoperatively, the image displayed on the laparoscopic monitor revealed a small tear in the vein. The inspired O 2 fraction was raised to 1.0, intravenous phenylephrine (0.1 mg bolus) was administered, and the respiratory rate was increased. After the patient was stabilized, the injured vein was cut and sealed. After the embolic event, the entire operation was completed without complications. Conclusions Careful observation of the laparoscopic monitor is important, particularly during establishment of pneumoperitoneum in patients undergoing laparoscopic hepatectomy.
Abstract Background: Continuous interscalene block is widely used for pain management in shoulder surgery. However, continuous interscalene block performed using the catheter-through-needle method is reportedly associated with adverse events such as pericatheter leakage of the local anesthetic, phrenic nerve paralysis, and hoarseness. Because we expected that the catheter-over-needle method would reduce these adverse events, we examined cases in which continuous interscalene block was performed using the catheter-over-needle method to determine what adverse events occurred and when. Methods: We retrospectively reviewed the anesthesia and medical records of adult patients who underwent catheter insertion to receive a continuous interscalene block performed using the catheter-over-needle method at our hospital from July 2015 to July 2017. Results: During the surveillance period, 122 adult patients underwent catheter insertion to receive a continuous interscalene block administered using the catheter-over-needle method. No case of pericatheter local anesthetic leakage was observed. Adverse events, such as dyspnea, hoarseness, insufficient anesthetic effect, dizziness, cough reflex during drinking, or ptosis, were observed in 42 patients (34.4%; 95% confidence interval 26–42.7). Most of the adverse events occurred on postoperative day 2. The median time between surgery and the onset of adverse events was 28.5 h. Conclusions: The catheter-over-needle method may prevent the pericatheter leakage of the local anesthetic. However, adverse events occurred in more than one-third of the patients. During continuous interscalene block, patients must be carefully observed for adverse events, especially on postoperative day 2. Trial registration: This study was registered at the UMIN Clinical Trials Registry on August 13th, 2019 (UMIN000037673).
Although rare, rhabdomyolysis is a serious complication of cardiothoracic surgery. Daptomycin is a polypeptide antimicrobial agent used to treat methicillin-resistant Staphylococcus aureus (MRSA) infections of the soft tissues. Daptomycin is associated with elevations in serum creatine kinase (CK). A 50-year-old man with acute Stanford A-type aortic dissection was performed Bentall procedure and total arch replacement with frozen elephant trunk. The CK level was 6,573 U/L on the first postoperative day (POD), suggesting rhabdomyolysis associated with lower limb ischemia. The CK level increased to 11,934 U/L on POD 2 and started to decrease thereafter. On POD 5, the patient had a suspected surgical site infection. Antibiotics were changed to empiric therapy of daptomycin and meropenem to address soft tissue MRSA infection. The CK level at the start of daptomycin administration was 4,122 U/L. However, the CK level rose to 21,813 U/L on POD 6. None of the findings suggested new-onset lower limb ischemia. Assuming that the rhabdomyolysis was induced by daptomycin, it was discontinued. The CK level peaked at 26,123 U/L on POD 8, after which it started to decrease and normalized on POD 16. Daptomycin should be used with extreme caution in patients recovering from rhabdomyolysis.
Abstract Background One-lung ventilation is a standard technique for thoracic anesthesia. Usually, one-lung ventilation requires a large-bore tracheal tube. Therefore, in patients with vocal cord morbidity, it is challenging to achieve one-lung ventilation while preventing the damage of vocal cord lesions. Case presentation A 77-year-old man was diagnosed with vocal cord cancer and lung tumor. One-lung ventilation with a combination of a laryngeal mask airway and bronchial blocker was planned to avoid unexpected vocal cord injury. After securing the airway with a laryngeal mask airway, a bronchial blocker was placed under fiberscope guidance. The bronchial blocker passed through a position far enough from the vocal cord lesion. The bronchial blocker provided a clear view of the operative field. The patient’s perioperative course was uneventful. Conclusions When one-lung ventilation is required for patients with vocal cord lesions, a combination of a laryngeal mask airway and bronchial blocker is considered a good option.
Abstract Nerve block is useful for the treatment of acute pain and cancer pain; however the treatment's effectiveness with regard to non-cancer chronic pain is controversial. Of the non-cancer diseases, trigeminal neuralgia and spinal facet joint pain, in which long-term pain relief can be obtained by the nerve block without serious complications in most of patients, are well suited for the nerve block. Systemic reviews for the treatment of radicular pain from spine disorders with the nerve block showed contradictory long-term results. In other chronic pains, the effectiveness of nerve blocks has not been proved, although anecdotal reports suggests that a small proportion of patients respond well to the nerve block. Further study is necessary to examine what kinds of pains and patients will be relieved with the nerve block.
Abstract Purpose Continuous interscalene block is widely used for pain management in shoulder surgery. However, continuous interscalene block using the catheter-through-needle method reportedly causes adverse events, such as pericatheter leakage of the local anesthetic, phrenic nerve paralysis, and hoarseness. Because we expected the catheter-over-needle method to reduce those adverse events, we analyzed cases in which continuous interscalene block was administered using the catheter-over-needle method to determine when and what adverse events occurred.Methods We retrospectively reviewed anesthesia and medical records of adult patients who inserted the catheter with a continuous interscalene block administered with the catheter-over-needle method at our hospital from July 2015 to July 2017.Results During the surveillance period, 122 adult patients inserted the catheter with a continuous interscalene block administered using the catheter-over-needle method. We found no case of pericatheter local anesthetic leakage. Other adverse events—dyspnea, hoarseness, insufficient anesthetic effect, dizziness, cough reflex during drinking, or ptosis—were observed in 42 cases (34.4%). Most of the adverse events occurred on postoperative day 2. The median time between surgery and onset of the adverse event was 28.5 hours.Conclusions The catheter-over-needle method may prevent the pericatheter leakage of the local anesthetic. However, the number of other adverse events that occurred with continuous interscalene block was remarkable. During continuous interscalene block, patients must be observed carefully for adverse events, especially on postoperative day 2.
