scholarly journals A Case of Hyperventilation leading to apnea and desaturation in PACU

2019 ◽  
Author(s):  
Parineeta Thapa ◽  
Subedi Asish ◽  
Poudel Anjali ◽  
Baral Pankaj
Keyword(s):  
General Anesthesia ◽  
Respiratory Alkalosis ◽  
Post Anesthesia Care Unit ◽  
Early Recovery ◽  
Case Presentation ◽  
Algorithmic Approach ◽  
Cortical Mastoidectomy ◽  
Recovery From Anesthesia ◽  
Bag And Mask Ventilation ◽  
Possible Cause

Abstract Background: Respiratory adverse events are not uncommon in the post anesthesia care unit (PACU) following general anesthesia. In this regard, hyperventilation leading to apnea and desaturation is a rare entity. Here we have reported a case of a 15-year-old girl who, following an uneventful general anesthesia, developed severe hyperventilation leading to apnea and desaturation in the PACU. Case presentation: The 15-year-old girl underwent cortical mastoidectomy under general anesthesia. After a smooth anesthesia and an uneventful early recovery, she developed hyperventilation after about 15 minutes in the PACU. The symptom was severe enough to lead to apnea, desaturation and severe respiratory alkalosis. She required bag and mask ventilation and the symptoms resolved only transiently with propofol sedation. Finally she responded to intravenous haloperidol and did not have any further episode after receiving haloperidol Conclusion: Hyperventilation after a smooth recovery from anesthesia is not a common presentation. In this article we have tried to discuss the possible cause of such symptom in our patient and how we successfully managed this case. We have also proposed an algorithmic approach to diagnose and manage such a case in the PACU.

scholarly journals A case of hyperventilation leading to apnea and desaturation in PACU

2019 ◽  
Author(s):  
Parineeta Thapa ◽  
Subedi Asish ◽  
Poudel Anjali ◽  
Baral Pankaj
Keyword(s):  
General Anesthesia ◽  
Respiratory Alkalosis ◽  
Post Anesthesia Care Unit ◽  
Early Recovery ◽  
Case Presentation ◽  
Algorithmic Approach ◽  
Cortical Mastoidectomy ◽  
Recovery From Anesthesia ◽  
Bag And Mask Ventilation ◽  
Possible Cause

Abstract Background: Respiratory adverse events are not uncommon in the post-anesthesia care unit (PACU) following general anesthesia. In this regard, hyperventilation leading to apnea and desaturation is a rare entity. Here we have reported a case of a 15-year-old girl who, following an uneventful general anesthesia, developed severe hyperventilation leading to apnea and desaturation in the PACU. Case presentation: The 15-year-old girl underwent cortical mastoidectomy under general anesthesia. After a smooth anesthesia and an uneventful early recovery, she developed hyperventilation after about 15 minutes in the PACU. The symptom was severe enough to lead to apnea, desaturation and severe respiratory alkalosis. She required bag and mask ventilation and the symptoms resolved only transiently with propofol sedation. Finally, she responded to intravenous haloperidol and did not have any further episode after receiving haloperidol. Conclusion: Hyperventilation after a smooth recovery from anesthesia is not a common presentation. In this article we have tried to discuss the possible cause of such symptom in our patient and how we successfully managed this case. We have also proposed an algorithmic approach to diagnose and manage such cases in the PACU.

scholarly journals A Case of Hyperventilation leading to apnea and desaturation in PACU: A root cause analysis

2019 ◽  
Author(s):  
Parineeta Thapa ◽  
Subedi Asish ◽  
Poudel Anjali ◽  
Baral Pankaj
Keyword(s):  
General Anesthesia ◽  
Respiratory Alkalosis ◽  
Early Recovery ◽  
Case Presentation ◽  
Algorithmic Approach ◽  
Root Cause ◽  
Cortical Mastoidectomy ◽  
Recovery From Anesthesia ◽  
Bag And Mask Ventilation ◽  
Possible Cause

Abstract Background Respiratory adverse events are not uncommon in the post anesthesia care unit (PACU) following general anesthesia. In this regard, hyperventilation leading to apnea and desaturation is a rare entity. Here we have reported a case of a 15 year old girl who, following an uneventful general anesthesia, developed severe hyperventilation leading to apnea and desaturation in the PACU. Case presentation The 15 year old girl underwent cortical mastoidectomy under general anesthesia. After a smooth anesthesia and an uneventful early recovery, she developed hyperventilation after about 15 minutes in the PACU. The symptom was severe enough to lead to apnea, desaturation and severe respiratory alkalosis. She required bag and mask ventilation and the symptoms resolved only transiently with propofol sedation. Finally she responded to intravenous haloperidol and did not have any further episode after receiving haloperidol Conclusion Hyperventilation after a smooth recovery from anesthesia is not a common presentation. In this article we have tried to discuss the possible cause of such symptom in our patient and how we successfully managed this case. We have also proposed an algorithmic approach to diagnose and manage such a case in the PACU.

scholarly journals Anesthetic management for a patient with myotonic dystrophy with remimazolam

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yasuhiro Morimoto ◽  
Aya Yoshimatsu ◽  
Manabu Yoshimura
Keyword(s):  
General Anesthesia ◽  
Myotonic Dystrophy ◽  
Anesthetic Management ◽  
Complete Recovery ◽  
Spontaneous Respiration ◽  
Verbal Command ◽  
Case Presentation ◽  
Intravenous Anesthetic ◽  
Increased Sensitivity ◽  
Recovery From Anesthesia

Abstract Background Patients with myotonic dystrophy may have increased sensitivity to drugs used for anesthesia. We successfully managed general anesthesia in a patient with myotonic dystrophy using a novel intravenous anesthetic, remimazolam. Case presentation The patient was a 46-year-old man, 169 cm in height, and weighing 60 kg. He was diagnosed with myotonic dystrophy 5 years previously. Phacoemulsification for both eyes was scheduled under general anesthesia. Anesthesia was induced with remimazolam 6 mg/kg/h for 1 min and maintained by continuous infusion at 0.25 mg/kg/h during surgery, a 1/4 dose of the standard infusion rate, as indexed by a bispectral index (BIS). Six minutes after remimazolam discontinuation, the patient opened his eyes on verbal command with sufficient spontaneous respiration. Flumazenil (0.2 mg) was administered to boost the patient’s recovery. Conclusion In addition to the short-acting anesthetic remimazolam, the presence of the antagonist flumazenil enabled complete recovery from anesthesia, without postoperative complications.

scholarly journals Esophageal achalasia detected by vomiting during induction of general anesthesia: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kyoko Abe ◽  
Tetsu Kimura ◽  
Yukitoshi Niiyama
Keyword(s):  
General Anesthesia ◽  
Orthopedic Surgery ◽  
Heller Myotomy ◽  
Esophageal Achalasia ◽  
Anesthesia Induction ◽  
Dor Fundoplication ◽  
Case Presentation ◽  
History Of ◽  
Recovery From Anesthesia ◽  
Risk Of Aspiration

Abstract Background Esophageal achalasia is a rare disease with a high risk of aspiration during anesthesia induction. Here, we describe our experience involving a case of undiagnosed esophageal achalasia with profuse vomiting during anesthesia induction. Case presentation A 58-year-old woman was scheduled for orthopedic surgery under general anesthesia. She vomited a large amount of watery contents during anesthesia induction, and planned surgery was postponed. After recovery from anesthesia, she informed us that she usually had to drink a large amount of water to get food into her stomach and purged watery vomit every night before sleep. However, she attributed it to her constitutional problem, not to a specific disease. She was subsequently diagnosed with esophageal achalasia and underwent Heller myotomy with Dor fundoplication before her re-scheduled orthopedic surgery. Conclusions A detailed history of dysphagia and regurgitation should be taken in preoperative examinations to prevent unexpected aspiration due to undiagnosed achalasia.

Muscle Tone Assessment under General Anesthesia for Sjögren-Larsson Syndrome and Spasticity

2021 ◽  
Vol 56 (2) ◽  
pp. 163-165
Author(s):  
George Georgoulis ◽  
Argyrios Dinopoulos ◽  
Emmanouil Gkliatis
Keyword(s):  
General Anesthesia ◽  
Muscle Tone ◽  
Muscle Relaxants ◽  
Spastic Diplegia ◽  
Case Presentation ◽  
Neurosurgical Procedure ◽  
Dorsal Rhizotomy ◽  
Severe Spasticity ◽  
Larsson Syndrome ◽  
Rule Out

Introduction: Study of muscle tone in individuals with severe spasticity (Modified Asworth Scale – MAS:3) under general anesthesia can confirm or rule out the eventual necessity of the impending spasticity relieving ablative neurosurgery by observing the hypertonia reduction and passive range of motion expansion. Therefore, what we measure under muscle relaxants is practically a fixed deformity. Case Presentation: The study was performed on a girl with Sjögren-Larsson syndrome, presenting with icthyosis and spastic diplegia. Proposed intervention was Dorsal Rhizotomy. Under general anesthesia, with and without muscle relaxants, hypertonia was significantly reduced (MAS:1), but the angle of motion did not increase much. Conclusion: We decided not to perform such a neurosurgical procedure. In ambiguous situations, the proposed study can help in decision-making for spasticity treatment.

scholarly journals Transient maintenance of tracheal patency upon the insertion of a flexible bronchoscope in a patient with an anterior mediastinal mass: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Takayuki Hasegawa ◽  
Shinju Obara ◽  
Rieko Oishi ◽  
Satsuki Shirota ◽  
Jun Honda ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Mediastinal Mass ◽  
Balloon Dilation ◽  
Maximum Flow ◽  
Anterior Mediastinal Mass ◽  
Positive Pressure ◽  
Anesthesia Induction ◽  
Flexible Bronchoscope ◽  
Case Presentation ◽  
Tracheal Collapse

Abstract Background Patients with an anterior mediastinal mass are at risk of perioperative respiratory collapse. Case presentation A 74-year-old woman with a large anterior mediastinal mass that led to partial tracheal collapse (shortest diameter, 1.3 mm) was scheduled for tracheobronchial balloon dilation and stent placement under general anesthesia. Although veno-venous extracorporeal membrane oxygenation (V-V ECMO) had been established, maximum flow was limited to 1.6 L/min, and general anesthesia induction was followed by hypoxia probably due to inadequate ventilation. A flexible bronchoscope was inserted through the tracheal lumen that was being compressed by the anterior mass; this not only increased tracheal patency but also enabled positive pressure ventilation and resulted in recovery from hypoxia. Scheduled procedures were successfully performed without complications. Conclusion We describe a case wherein tracheal patency was transiently maintained by inserting a flexible bronchoscope in a patient with an anterior mediastinal mass.

scholarly journals Excessive dynamic airway collapse during general anesthesia: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Shunichi Murakami ◽  
Shunsuke Tsuruta ◽  
Kazuyoshi Ishida ◽  
Atsuo Yamashita ◽  
Mishiya Matsumoto
Keyword(s):  
General Anesthesia ◽  
Airway Pressure ◽  
Positive End Expiratory Pressure ◽  
Computed Tomography Scan ◽  
Case Presentation ◽  
Airway Lumen ◽  
Asthma Attack ◽  
Airway Collapse ◽  
History Of ◽  
Tomography Scan

Abstract Background Excessive dynamic airway collapse (EDAC) is an uncommon cause of high airway pressure during mechanical ventilation. However, EDAC is not widely recognized by anesthesiologists, and therefore, it is often misdiagnosed as asthma. Case presentation A 70-year-old woman with a history of asthma received anesthesia with sevoflurane for a laparotomic cholecystectomy. Under general anesthesia, she developed wheezing, high inspiratory pressure, and a shark-fin waveform on capnography, which was interpreted as an asthma attack. However, treatment with a bronchodilator was ineffective. Bronchoscopy revealed the collapse of the trachea and main bronchi upon expiration. We reviewed the preoperative computed tomography scan and saw bulging of the posterior membrane into the airway lumen, leading to a diagnosis of EDAC. Conclusions Although both EDAC and bronchospasm present as similar symptoms, the treatments are different. Bronchoscopy proved useful for distinguishing between these two entities. Positive end-expiratory pressure should be applied and bronchodilators avoided in EDAC.

scholarly journals Formulating an anesthetic plan using a list of high-risk pregnant women on cloud-based business communication tools: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Junnosuke Kimura ◽  
Kento Kawamura ◽  
Manami Minoura ◽  
Ayako Hiramoto ◽  
Yoshifumi Suga ◽  
...  
Keyword(s):  
Case Report ◽  
High Risk ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Pregnant Women ◽  
Cesarean Delivery ◽  
Business Communication ◽  
Communication Tools ◽  
Case Presentation ◽  
Emergency Cesarean

Abstract Background We report a case in which a list of high-risk pregnant women on cloud-based business communication tools was useful in formulating an anesthetic plan for unscheduled cesarean section. Case presentation A 37-year-old woman, who had been prescribed icosapentate for hypertriglyceridemia, received an antenatal anesthetic evaluation for possible cesarean delivery, and it was agreed that the anesthetic method for emergency cesarean section was general anesthesia if the surgery would take place within 7 days after the discontinuation of the drug, and regional anesthesia if it would take place any time later. Then this agreement was uploaded on the cloud-based business communication tools, and updated until she delivered her baby via unscheduled cesarean section. Conclusions A cloud-based business communication tools was useful in formulating an anesthesia plan for a patient undergoing a cesarean delivery. However, more discussion would be needed to utilize it in security.

scholarly journals Duplication of Inferior Vena Cava, Possible Cause of Internal Hernia? Literature Review and Rare Case Presentation

Chirurgia ◽  
2020 ◽  
Vol 115 (5) ◽  
pp. 665
Author(s):  
Cedric Kwizera ◽  
Daniel G. Popa ◽  
Marian Botoncea ◽  
Adrian Tudor ◽  
Gyorgy D. Szava ◽  
...  
Keyword(s):  
Literature Review ◽  
Inferior Vena Cava ◽  
Internal Hernia ◽  
Rare Case ◽  
Inferior Vena ◽  
Vena Cava ◽  
Case Presentation ◽  
Possible Cause

scholarly journals Laparoscopic management of isolated metachronous adrenal metastases in a patient with esophageal cancer: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Tarun Jindal ◽  
Ankush Sarwal ◽  
Pravin Pawar ◽  
M. Dhanalakshmi ◽  
Neeraj Subedi
Keyword(s):  
Esophageal Cancer ◽  
Laparoscopic Approach ◽  
Early Recovery ◽  
Term Survival ◽  
Invasive Approach ◽  
Case Presentation ◽  
Ivor Lewis ◽  
Asian Ethnicity ◽  
Laparoscopic Excision

Abstract Background The presence of isolated metachronous adrenal metastasis in patients with esophageal cancer is rare. There is significant controversy regarding the management of such patients. Adrenal metastasectomy has been shown to be of benefit in some reports. Minimally invasive approach, although the gold standard for adrenalectomy, has not been used commonly in a postesophagectomy setting owing to the anticipated technical difficulties. We describe one such case wherein this approach helped in early recovery and long-term survival. Case presentation A 59-year-old male of Asian ethnicity presented with an isolated left adrenal nodule, 3 years after an Ivor Lewis esophagectomy for a lower esophageal adenocarcinoma. The biopsy of the nodule was suggestive of metastatic adenocarcinoma. The patient underwent laparoscopic excision of the left adrenal gland. Conclusion Adrenal metastasectomy, in postesophagectomy patients can provide good oncological control. Laparoscopic approach, though technically challenging, can provide results equivalent to those of open surgery, albeit with less morbidity.

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