Airway Obstruction due to Hematoma Following Internal Jugular vein Cannulation

A patient developed neck swelling and acute airway obstruction following an internal jugular vein cannulation. During laryngoscopy, glottic exposure was impossible because of a hematoma-induced anatomical distortion of standard laryngeal landmarks. Finally, a nasotracheal tube was intubated into the trachea fibreoptically. This life-threatening complication is rare, possible origin and mechanism for the sudden hematoma are discussed, as well as the airway management

ドッキョウ イカ ダイガク デ ハジメテ ノ ノウシ カラノ ゾウキ テキシュツ ジュツ ノ マスイ ケイケン

獨協医科大学で初めての脳死下臓器摘出術の麻酔を経験した.ドナーは50歳代の女性で,くも膜下出血による脳死であり,麻酔および摘出術は特に問題なく終了した.臓器摘出術の麻酔管理の主な要点は,各摘出臓器の機能を最大限に維持するための適切な循環および呼吸管理である.本症例におけるわれわれの経験は近い将来,獨協医科大学で行われるであろう臓器摘出術及び移植術の麻酔管理に有益な情報になると考えられた.We report the anesthetic management of the first case ofthe brain death for organ donation in Dokkyo Medical University.The donor was brain death after subarachnoidhemorrhage. Anesthesia and surgical procedure were doneuneventfully. The aims of anesthetic management are tomaintain optimal organ perfusion. We believe that this firstexperience will be helpful for the anesthetic management ofthe organ transplantation patient in the future of DokkyoMedical University

チョウオンパ ガイド カ センコツ コウマク ガイ ブロック : センコツ トノ カイボウガク テキ ケントウ

仙骨硬膜外ブロックは外科手術の麻酔あるいは慢性疼痛の除痛手段に対して用いられる.従来のランドマーク法による仙骨硬膜外ブロックは小児では容易で安全であるとされているが,成人では70〜80%の成功率とされている.本研究では超音波ガイド下仙骨硬膜外ブロックを成人患者50症例で施行してその有用性を検討した.結果は全症例にてブロックは成功した.さらに超音波ガイド下仙骨硬膜外ブロックの成功率と安全性をより高くするために仙骨裂孔(仙骨角)の形態変異を観察し,得られた超音波画像の関係を検討した.Caudal epidural block is often used in patients for anesthesiaand chronic pain. Caudal epidural block with surfacelandmark guidance has been generally considered simpleand safe to perform especially in child patients. However,the success rate of the block in adults has been 70-80 % inthe literature. This study was aimed to determine the clinicalefficacy of caudal epidural block using ultrasound in 50patients. All the blocks were performed successfully. In addition,to increase both success rate and safety of ultrasoundguided caudal block, an anatomical study of thesacral hiatus( sacral cornu) has been performed to demonstratethe type and frequency of the shape variations tocompare with ultrasound imagings

ナイ ジカク ニ タイ スル リュウサン アルミニウム ・ タンニン サン チュウシャ エキ ( ALTA ) リョウホウ シコウ 5 カゲツゴ ニ ショウジ タ コウモン カン ・ チョクチョウ ネンマク ヘンセイ ノ 1 レイ : ALTA シコウ ゴ ノ ネンマク ヘンセイ

症例60歳女性,10年来の脱出性内痔核の治療として2014.2.12硫酸アルミニウムカリウム・タンニン酸注射液(Aluminium Potassium Sulfate Tannic Acid:以下ALTA)を使用した四段階注射痔核硬化療法を受けた.経過良好であったが,7月中旬よりの肛門痛・発熱にて入院,触診のみでボロボロ崩れ落ちてゆく5時方向を中心とした約1/4周を占める広範な肛門管・直腸粘膜変性壊死を認めデブリードマン施行.疼痛・発熱は持続したが,禁食,抗生物質・解熱剤の投与,2回の追加デブリードマンにて,変性壊死部位は脱落し潰瘍と変化し,一か月後軽快退院した.非常に稀な経過と考えられたため報告した.Recently, the number of the Aluminum Potassium Sulfate and Tannic Acid(ALTA)injections therapy for internal hemorrhoids have been increasing markedly in Japan because of its minimal invasive therapy, quick response and acceptable recurrence rate. However, there are some reports of adverse reactions and side effects after ALTA such as Fournier\u27s Gangrene, rectovaginal fistula and rectal ulcer. We experienced a case of anorectal mucosal degeneration and necrosis after five months ALTA injection for internal hemorrhoids. A 60 year-old female was treated with sclerosing therapy with ALTA injection for grade II～III internal hemorrhoids according to the Gligher classification. Although the patient was in good course in 5 months after therapy, she developed a high fever and anal pain. Antibiotics were administrated, but remission was not achieved. Three times debridements were performed under local and intravenous anesthesia with a diagnosis of anorectal mucosal degeneration and necrosis. After approximately a month admission in the hospital was necessary for the treatment of the anorectal ulcer after debridements, she has been free from fever, pain and hemorrhoids