Minimally invasive cardiac surgery (MICS) requires lung isolation. Lung isolation is usually achieved with double-lumen endotracheal tube (DLT). Patients with idiopathic thrombocytopenic purpura (ITP) have an increased risk of bleeding events. We suspected endobronchial hemorrhage after exchange of DLT during induction of anesthesia for replacement of mitral valve in a 62-year-old man with a known ITP. The MICS was stopped and bronchial artery embolization was performed in the angiographic room. In the present case, in order to reduce the risk of bronchial arterial injury in ITP patient we intubated with single lumen endotracheal tube. Lung isolation led to achievement of intermittent total lung deflation. Based on the results, we recommend a high-dose intravenous immunoglobulin therapy and platelet transfusion prior to cardiac surgery in patients with ITP to increase platelet count. Moreover, it is proposed that in order to clear the vision during the operation, ventilation can be held or made intermittent both prior to cardiopulmonary bypass or at its conclusion to permit exposure.
We report a case of a patient with a double-primary aortoenteric fistula with an abdominal aortic aneurysm. A 75-year-old man was taken to the operating room for the repair of an abdominal aortic aneurysm and a suspected aortoenteric fistula between the aorta and sigmoid colon. Sudden onset of massive bleeding through the nasogastric tube occurred after the induction of anesthesia. Surgical exploration confirmed an unexpected aortoduodenal fistula. Primary aortoenteric fistula is extremely rare and difficult to diagnose, and may cause fatal bleeding. The possibility of the presence of aortoenteric fistula, including multiple types, should be considered in the anesthetic management of abdominal aortic aneurysm.
Certain oral procedures require a sedated patient who is responsive to allow for the mouth opening and position change. Dexmedetomidine is a relatively selective alpha2-adrenoceptor agonist with sedative, analgesic, amnestic, and anesthetic-sparing effects. Large dose dexmedetomidine is suitable as a single agent for sedation and anxiolysis for plate removal in a patient with bilateral sagittal split osteotomy and Lefort 1 osteotomy with genioplasty.Key Words: Dexmedetomidine, Sedation, Oral procedure A 25-year-old, 50 kg, 160 cm woman with surgical history of bilateral sagittal split osteotomy (BSSO) and Lefort 1 osteotomy with genioplasty, was scheduled for plate and screw removal. In the operating room, standard ASA monitors were applied with a MAC-safe nasal cannula to monitor end-tidal CO 2 concentration (Fig. 1). Dexmedetomidine was initiated with an intravenous (IV) loading dose of 1 mcg/kg delivered over 10 minutes, followed by an infusion rate of 1 mcg/kg/hr. Subsequently, the dexmedetomidine infusion was titrated to effect and stoped when the main part ofthe procedure was completed.The patient was then prepped and draped in a standard fashion for an orthognathic surgical procedure. The patient's oropharynx was thoroughly irrigated and suctioned free of debris. 10 ml of 2%
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