Abstract
An 87-year-old female patient had been diagnosed with left mandibular gingival cancer. Under general anesthesia she underwent partial excision of the mandible, resection of the superior cervical lymph nodes and palatal reconstruction. Her history revealed left facial palsy and goiter, but no specific treatment had been previously administered for these conditions.
Preoperatively atropine sulfate and midazolam were administered intramuscularly. Anesthesia was introduced by m-NLA and included nitrous oxide, oxygen, midazolam and pentazocine. Anesthesia was subsequently maintained with nitrous oxide, oxygen and sevoflurane. The course of surgery was uneventful and was completed in 7 hours and 25 minutes. The patient regained her consciousness uneventfully.
Approximately three hours after returning to the ward, she began to show signs of unrest. She was heavily sedated with an intramuscular dose of midazolam (5mg). However, about 7 hours after returning to the ward, airway obstruction developed, apparently due to edema and bleeding from the site of surgery, making it impossible for her to breathe spontaneously. An emergency tracheotomy was performed, and spontaneous ventilation resumed. Later, she again showed signs of unrest. Despite four additional doses of midazolam (10mg in total), adequate sedation was not achieved. At that time, we considered possible disorders of the brain related to hypoxia caused by disturbed spontaneous ventilation and therefore commenced (thus started) low-dose drip infusion of thiamylal sodium (about 2mg/min). The infusion lasted for about 18 hours (2000mg thiamylal sodium in total). During this infusion, her condition was well controlled. Her mental state was clear about 9 hours after completion of infusion. Thereafter, she showed no noteworthy symptoms. The brain-protective effect of thiamylal sodium is remarkable and no other drug exerting such comparable effect is available at present. Our experience with this case again emphasizes the beneficial effect of thiamylal sodium and its usefulness in sedation of postoperative patients.
