妊娠後期巨大動靜脈畸形導 致顱內出血之病例報告及麻醉處置

妊娠期中因動靜脈畸形導致顱內出血是相當罕見，而且會造成母親及胎兒極大的危險 ，甚至死亡。本病例為一位二十六歲女性，在懷孕三十六週時，發現有巨大的動靜脈 畸形導致顱內出血。為了避免顱內壓力持續性升高，我們成功的在全身麻醉下施行剖 腹產，文章中我們也回顧眾多相關的文章來討論在腦血管瘤或顱內出血孕婦身上，全 身麻醉及區域麻醉上的考量及相關處理。 Intracranial hemorrhage ( ICH) from an arteriovenous malformation (AVM) in pregnancy is quite rare and could lead to exceedingly high maternal and fetal morbidity and mortality. We report a 26-year-old woman at 36weeks' gestation who sustained ICH due to two huge AVMs. For preventing from progressive increased intracranial pressure (IICP),Cesarean section under general anesthesia was performed successfully. Herein, we also discuss the anesthetic management after reviewing the related current literatures

Perioperative Complications of Liver Resection in the Elderly with Hepatocellular Carcinoma: A Comparison with Younger Patients

Background: Liver resection surgery in patients with hepatocellular carcinoma is a high-risk procedure with an in-hospital mortality rate around 5%. Patient age and volume of blood loss were found to be independent predictive factors of long-term outcomes in previous studies. We sought to clarify the age-related differences in the perioperative complications during the whole admission for liver resection surgery. Methods: This retrospective study included 210 patients scheduled for elective liver resection from July 2006 to July 2008. The characteristics of the patients, intraoperative events, and postoperative complications were retrieved from medical charts, anesthesia records stored in a computer database, and the quality assurance system in our department. The patients were divided into two groups: Group A, aged 60 years or older (n = 91); and Group B, aged younger than 60 years (n = 119). Postoperative complications and intraoperative parameters were compared using the Student's t test for continuous data, and χ2 test for categorical data. Correlations of age with blood loss, operation time, urine output, length of intensive care unit stay, total admission time, and intubation time were examined with the Pearson's correlation. Analysis of variance was used to investigate the endotracheal intubation time with different postoperative pain control methods. Results: No differences in intraoperative blood loss, total operation time, urine output during surgery, in-hospital death, difficulty of operation, and incidence of massive blood loss and oliguria were found between the two groups. The length of intensive care unit stay and total admission time were significantly longer in the elderly group (p = 0.04 and 0.01, respectively). There was a higher incidence of postoperative respiratory complications in the elderly as revealed by a longer intubation time in Group A than in Group B (p = 0.03). Conclusion: In contrast to some surgeries for emergency conditions such as long bone fracture or acute abdomen, the perioperative complications in the elderly receiving elective liver resection surgery did not differ markedly from those of younger patients. However, elderly patients would benefit even more if comprehensive postoperative care or newly improved therapies can be provided to lessen the incidence of perioperative respiratory complications

Patient-controlled analgesia for background pain of major burn injury

Background: Studies have suggested that intravenous patient-controlled analgesia (IV-PCA) can be used safely for the treatment of background pain in burn patients. However, no comprehensive protocols have been published. How patient or surgical factors correlate with the amount of opioid consumption remains unclear. The aim of this study is to provide an IV-PCA protocol for alleviating pain for burn injuries, and to assess factors correlated with opioid consumption. Methods: At the Mackay Memorial Hospital, a retrospective analysis from June 27th to October 31st of 2015 was carried out to investigate the use of IV-PCA in relation to the demographic and clinical data of patients who suffered from burn injuries due to a massive explosion of flammable powder. A standardized morphine IV-PCA protocol with rapid escalation was implemented. Variables assessed included age, weight, gender, days of usage, total surface area burned (TBSAB) and operations. Results: Among the 23 patients who received IV-PCA for burn pain control, it was noted that the larger the TBSAB and the higher the visual analogue scale (VAS), the more amount of morphine was consumed. Correlations between morphine consumption positively with weight (P < 0.01), female gender (P < 0.01), severity of injury (P = 0.01), and negatively with receiving operations (P = 0.01) were statistically significant. Conclusion: As the daily morphine consumption was positively correlated with TBSAB, VAS, weight, female gender, the use of our IV-PCA protocol was sufficient in the management of background pain for patients with major burn injury. Keywords: Burns, Analgesia, Patient-controlled, Pain, Body surface area, Visual analog scal

The Anesthetic Strategy for Patients with Mucopolysaccharidoses: A Retrospective Cohort Study

Anesthesia for patients with mucopolysaccharidoses (MPS) is quite challenging due to vital systemic dysfunction following progressive accumulation of lysosomal glycosaminoglycans. Previous studies focused on perioperative difficult airway management under general anesthesia but rarely depicted the concern of choosing the size of the endotracheal tube (ETT) as well as neuraxial anesthesia. This study aimed to analyze the overall anesthetic management and related complications for a thorough anesthetic strategy. Within the study period from 2002 to 2021, each record of the anesthetic and perioperative quality assurance/improvement system for patients with a diagnosis of MPS at MacKay Memorial Hospital was retrospectively reviewed. A total of 51 individuals with 151 anesthesia for 163 interventions were cohort studied, and there were 136 general anesthesia and 15 neuraxial anesthesia. We found that the most common interventions for MPS patients were otolaryngological surgeries (49.6%). Additionally, a secured airway played a marked preference for the most general anesthesia (87.1%). The incidence of difficult intubation was 12.5%. In view of ETT size, a smaller than estimated size was used in MPS type II, III, IV, and VI patients and also in patients who received intubation with multiple attempts. However, a larger than estimated size of ETT was adopted whilst choosing cuffed ones. For neuraxial anesthesia, two failed spinal anesthesia procedures were converted to general anesthesia and 73 percent of the patients received perioperative sedation. In conclusion, through the individualized anesthetic strategy and build-up of an experienced team for airway management, high-quality anesthesia can be ensured in each patient