BackgroundTo examine the response to an α2receptor agonist used as a sedative for patients using long-term selective α1 blockers.MethodsSixty-nine consecutive patients undergoing transurethral prostate resection or holmium laser resection of the prostateunder spinal anesthesia were divided into two groups; group N (n = 37), which did not receive α1 blockers, and group T (n = 32), which was administered tamsulosin for at least 1 month before the study. Bispectral index scores, Modified Observer’s Assessment of Alertness/Sedation scale scores, heart rate, and mean blood pressure were obtained under sedation using dexmedetomidine for 30 min during surgery.ResultsThe only significant difference found between the groups were mean bloodpressure 15 min after the first loading dose injection of dexmedetomidine. Differencesbetween both groupswere noted at 15 min(group T: 100.2 ± 12.9 mmHg; group N: 90.0 ± 17.5 mmHg; P = 0.08), 20 min (group T: 99.8 ± 12.3 mmHg; group N: 87.4 ± 15.0 mmHg; P < 0.00), 25 min (group T: 99.3 ± 13.4 mmHg; group N: 85.4 ± 13.8 mmHg; P < 0.00), and 30 min (group T: 98.8 ± 13.1 mmHg; group N: 84.5 ± 13.5 mmHg; P < 0.00).ConclusionsThe use of α2 agonists is appropriate during surgery for benign prostatic hyperplasia patients using tamsulosin, and there is no need to alter the dose. Alertness with anesthesia involving α2 agents was maintained for patients using long-term tamsulosin and patients who did not use tamsulosin.Trial registrationThe study was retrospectively registered with the Clinical Research Informational Service (KCT0002967, July 2, 2018).Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0598-1) contains supplementary material, which is available to authorized users.
BACKGROUND Spinal anesthesia is commonly used for various surgeries. While many complications occur after induction of spinal anesthesia, involuntary movement is an extremely rare complication. CASE SUMMARY Herein, we report the case of a 54-year-old healthy male patient who experienced involuntary movements after intrathecal injection of local anesthetics. This patient had undergone metal implant removal surgery in both the lower extremities; 7 h after intrathecal hyperbaric bupivacaine administration, involuntary raising of the left leg began to occur every 2 min. When the movement disorder appeared, the patient was conscious and cooperative. No other specific symptoms were noted in the physical examination conducted immediately after the involuntary leg raising started; moreover, the patient's motor and sensory assessments were normal. The symptom gradually subsided. Twelve hours after the symptom first occurred, its frequency decreased to approximately once every three hours. Two days postoperatively, the symptoms had completely disappeared without intervention. CONCLUSION Anesthesiologists should be aware that movement disorders can occur after spinal anesthesia and be able to identify the cause, such as electrolyte imbalance or epilepsy, since immediate action may be required for treatment. Furthermore, it is crucial to know that involuntary movement that develop following spinal anesthesia is mostly self-limiting and may not require additional costly examinations.
BACKGROUND Zoster sine herpete (ZSH) can be misdiagnosed because there are no typical vesicular eruptions characterized by a dermatomal distribution. However, incorrect treatment due to a misdiagnosis can lead to severe pain and fatal complications. CASE SUMMARY A 75-year-old woman complained of sudden onset right shoulder pain and atypical headache. After 18 d, sudden hearing loss occurred in the left ear. In serology tests conducted after the onset of hearing loss, varicella-zoster virus IgM was positive. She had no history of a rash or trauma. Under the suspicion of ZSH, antiviral treatment and stellate ganglion block were administered four times, and the pain was effectively controlled. CONCLUSION Early diagnosis and treatment of ZSH can help not only by reducing pain but also by preventing fatal complications.
BACKGROUNDFiberoptic bronchoscopic intubation is the gold standard for endotracheal intubation in difficult or compromised airway situations. However, oxygen insufflation through the working channel of a fiberscope is a controversial method because of the possibility of gastric distention and rupture during an awake fiberoptic bronchoscopic intubation, despite the advantages of preventing fogging of the fiberoptic bronchoscopic lens, blowing oral secretions away, and oxygenation of patients.CASE SUMMARYHere, we describe a case of cervical instability where we rapidly performed fiberoptic bronchoscopic intubation using oxygen insufflation through working channel of the broncoscopy to administer general anesthesia after two previous failures due to low visibility. A 50-year-old man with a non-specific medical history underwent emergency cervical spine surgery for posterior fusion of the C2 and C3 vertebrae. After two unsuccessful attempts at intubation using the fiberoptic broncoscopy, we performed it successfully using the oxygen insufflation via the working channel, instead of using suction to remove the secretion from the lens.CONCLUSIONOxygen insufflation via the working channel of the broncoscopy is a useful method for assisting with difficult intubation cases.
Incentive spirometry reduces pleural pressure and induces lung expansion by making the patient's breath long, slow, and deep [1]. Consequently, this method effectively minimizes lung atelectasis, strengthens inspiratory muscles, and optimizes gas exchange [1-3]. Due to the advantages outlined above, incentive spirometry is widely used in many medical centers to reduce postoperative pulmonary complications in high-risk patients or for respiratory rehabilitation in the patients with respiratory muscle weakness [1,2]. The limitations of incentive spirometry include ineffectiveness due to inappropriate use, hyperinflation, respiratory alkalosis, fatigue, pain, and hypoxia due to interruption of oxygen supply during the procedure [1,3]. The following contraindications of incentive spirometry are known: (1) the patients in an en-vironment where proper device use cannot be supervised; (2) uncooperative patients; (3) the patients who cannot understand how to properly use the device; (4) the patients who cannot breathe deeply in an effective way; (5) the patients with severe chronic obstructive pulmonary disease or acuteasthma who are at risk of developing hyperinflation due to the limited full expiration when using the device [1,3]. However, according to our literature review, severe complications from incentive spirometry have rarely been reported; likewise, no reports are available about the precautions when applying incentive spirometry. In the present study, we report a case of pharyngeal reperforation following incentive spirometry in a patient who underwent head and neck surgery.
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