Planning safe perioperative management for patients undergoing continuous ambulatory peritoneal dialysis (CAPD) catheter surgery (insertion and extraction of the catheter) is often difficult because many of these patients not only have renal insufficiency but also have co-existing disorders, such as heart diseases. As increased indications for perioperative anticoagulation therapy have limited the choice of anesthesia, selecting an appropriate anesthetic method, particularly for patients with poor systemic conditions, is becoming more challenging. We report seven cases of CAPD catheter surgery successfully managed by monitored anesthesia care using subcostal transversus abdominis plane (TAP) block with additional local anesthetic infiltration and analgesics. Despite co-existing cardiac disease and/or coagulation disorders, all patients were safely managed without any other major anesthetic methods. Subcostal TAP block is a useful anesthetic option for CAPD catheter surgery, particularly for patients with poor systemic conditions and/or in whom neuraxial blocks are contraindicated.
When ultrasound-guided subgluteal sciatic nerve block is conducted, multiple injections of local anesthetic to make a circumferential spread around the sciatic nerve improve the rate of sensory and motor blocks compared with a single injection.
To aim of this study was to compare the feasibility and efficacy between two techniques of ultrasound-guided lateral femoral cutaneous nerve with or without locating the nerve. The study enrolled 106 patients undergoing knee surgery who received 5 ml of 1% mepivacaine immediately under the inguinal ligament 1 to 2 cm medial to the anterior superior iliac spine (subinguinal technique) or around the lateral femoral cutaneous nerve located (nervetargeting technique). The time required to perform the block and the onset time of the block were similar for both techniques. However, a significantly higher percentage of patients obtained loss of pinprick sensation on the lateral thigh within 10 minutes with the subinguinal technique than with the nerve-targeting technique. The findings suggest that ultrasound-guided lateral femoral cutaneous nerve blocks can be easily performed and that injecting local anaesthetic immediately under the inguinal ligament rather than around the nerve itself blocks the nerve more reliably.
Patients who have silent sick sinus syndrome (SSS) can show various unexpected arrhythmias during surgery. The severity of these bradyarrythmias is affected by anesthetic methods. We report a unique case of a patient with silent SSS who developed 40 s of asystole under combined general and epidural anesthesia. A 40-year-old woman with no apparent cardiac disease underwent abdominal hysterectomy. General anesthesia was induced and maintained with propofol, fentanyl, and vecuronium combined with thoracic epidural anesthesia. During surgery, severe bradycardia, triggered by peritoneal manipulation, occurred, leading to 40 s of asystole. She was diagnosed as having SSS by a postoperative 24-h Holter electrocardiogram. We propose that the possible existence of SSS should be kept in mind even in a patient who shows no abnormalities on routine preoperative examination, especially in those in whom vagomimetic anesthetic methods are used.
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