We evaluated the safety of desflurane (DES) anesthesia during one-lung ventilation (OLV) in patients undergoing thoracoscopic pulmonary surgery. 25 ASA physical status I-II patients (15 men and 10 women) were included in the study. During OLV, DES was applied with end tidal concentration of 4.0% and ventilation was set at the volume-controlled mode with 100% oxygen. PaO2 and maximum airway pressure were measured during OLV. However, no patient showed hypoxia and there was no significant change on maximum airway pressure during OLV. No patient showed abnormal increase of airway pressure. Postoperative nausea and vomiting occurred was more frequently in women than men (4women vs men, p<0.05). We concluded that DES anesthesia is safe and is not inferior to intravenous anesthesia during OLV.
Aim: The prothrombin time (PT) activity value, which is an essential factor in the Child-Pugh classification of liver disease, has not yet been standardized, causing confusion in the evaluation of hepatic reserve. The results of Child-Pugh classification were verified with the reagents used in Japan for PT measurement. Methods: The PT activity value (%) was measured with seven types of reagents in 147 patients with liver disease who gave their consent, from January 2014 to December 2016, and the hepatic reserve was compared based on the results from each reagent. Results: The seven types of PT measurement reagents verified covered 72.9% of the testing facilities in Japan. The average PT activity value of the same sample using the seven reagents was from 76.6 ± 19.2 (%) to 89.2 ± 20.2 (%), with a maximum deviation of 12.6%. A significant difference was found in the results from each measurement reagent in the statistical analysis (p<0.001). Moreover, in the Child-Pugh classification of the 147 cases, a maximum of 8 cases of Child-Pugh class A divergence from 88 cases to 96 cases were observed, depending on the reagent used to measure the PT activity value. Conclusions: Our results indicate that, based on the PT measurement reagents used by many facilities in Japan, the results from the same sample may differ, and the subsequent Child-Pugh classification, which is indispensable for the treatment of liver disease, may also vary according to the PT measurement reagent used.
A 36-year-old pregnant woman with a uterine myoma underwent a scheduled cesarean section under combined spinal-epidural anesthesia (CSEA). On postoperative day 3, she complained of headache while in a standing position. On postoperative day 8, her headache was ameliorated and she could walk by herself, so she was discharged from our hospital. However, on postoperative day 10, she was returned to our hospital by ambulance because she had vomited, was incontinent of urine, and had anisocoria. She had disturbance of consciousness and computed tomography examination of the head showed subdural hematoma (SDH). Emergency craniotomy was performed and the hematoma was successfully removed. Her condition improved, and she was discharged 13 days after craniotomy without subsequent complications. SDH after CSEA is rare, but diagnosis in early stage can decisively influence its prognosis. It is crucial to consider the possibility of SDH and accurately determine whether another unexplained symptom is responsible for a headache after dural puncture.
A man in his 60s, with a history of excessive alcohol consumption, underwent surgery for rectal cancer. During a follow-up visit, he complained of vomiting black-colored vomitus and abdominal pain. An upper gastrointestinal endoscopy was performed and the esophagus was found to be black in color. Therefore, he was diagnosed with acute necrotizing esophagitis. We treated him with central venous nutrition and administered Proton Pomp Inhibitors (PPI) and antibiotics. The patient resumed oral feeding on the 14th day and was discharged on the 18th day. However, six months later, he was hospitalized again for acute necrotizing esophagitis as he had not stopped drinking alcohol. The patient’s condition improved after central venous nutrition, fasting, and administering similar doses of antibiotics and PPI just as the initial treatment. He abstained from drinking alcohol after he was discharged and is alive without any recurrence.