[Anesthetic management of a pneumothorax patient with complete situs inversus].

We experienced a case of pneumothorax in a patient with complete situs inversus. A 30-year-old man was scheduled for partial resection of the left lung under video assisted thoracic surgery. He had asymptomatic complete situs inversus. We advanced a bronchial blocker easily into the left (anatomically right) main bronchus under fiberoptic guidance. One lung ventilation during the operation was performed successfully. The chest X-ray after the surgery showed an atelectasis of the left upper lobe. After endotracheal suction, we extubated him and noticed improvement of atelectasis. There are several ways of one lung ventilation in patients with situs inversus. To use a bronchial blocker is one of the effective choices. However, in some cases, it is necessary to consider using a double-lumen tube depending on the case considering the anatomical structure and the characteristics of the procedure.

[Remaining of a safety clip within the hub of the Surshield Surflow II i.v. catheter].

Terumo's Surshield Surflow II i.v. catheter automatically engages a stainless steel clip to shield its needle tip when the needle goes out from the catheter hub. However, in our experience the safety clip of Surshield Surflow II remains in the catheter hub in a high proportion of cases when the catheter hub is held with a pair of forceps. The hub wall is so thin that the force existed to hold the hub can be easily transmitted to the safety clip. Another factor is the loose attachment of the safety clip to the needle tip. To prevent needle stick injury, further improvement of safety i.v. catheters is necessary to lead their increased use.

[Anesthetic management for laparoscopic repair of Morgagni-Larry hernia in a child].

A 5-year-old asymptomatic boy was shown to have bowel loops in the thoracic cavity incidentally in a chest radiograph. A barium swallow confirmed the diagnosis of Morgagni hernia. Laparoscopic repair under CO2 pneumoperitoneum was performed. Anesthesia was induced and maintained with air, oxygen and sevoflurane. After pulling the transverse colon and the greater omentum into the abdomen, it was found that a part of the liver was also herniated into the right sternocostal hiatus (Larry hernia). The patient showed uneventful recovery. However, we should realize that dissection of adhesions between the viscera and peritoneal sac may be dangerous with possibility of pneumomediastinum or pneumothorax under pneumoperitoneum.