[Management for the removal of dopamin-secreting pheochromocytoma].

Incidence of dopamin-secreting pheochromocytoma is very rare. We reported managment of anesthesia for the removal of dopamin-secreting pheochromocytoma. A 46-year-old woman was diagnosed with pheochromocytoma, but lacking clinical symptoms. Plasma and urinary dopamine levels were remarkably elevated, but other catecholamine levels were within normal limits. She underwent left adrenalectomy. Plasma dopamine was measured before during and after the adrenalectomy. Blood pressure was not related to plasma dopamine levels.

[Management of one lung ventilation with bronchial blocker catheter for a patient with tracheobronchopathia osteochondroplastica].

Tracheobronchopathia osteochondroplastica is a rare benign disease, with difficult airway for intubation because the trachea and bronchia are narrow and transformed. We experienced one lung ventilation for a patient with the lung cancer associated with the tracheobronchopathia osteochondroplastica. The Coopdech bronchial blocker is a device for one lung ventilation. We could actually manipulate the blocker balloon very easily and maintain complete one lung ventilation maintaining SpO2 well. Coopdech bronchial blocker is useful for one lung ventilation in a patient with difficult airway such as tracheobronchopathia osteochondroplastica.

[Management of maternal tetanus contracted by an obstetric procedure].

A 34-year-old woman from the Philippines showed difficulty in opening the mouth. She had no wounds in the last one mouth, but was treated with an obstetric procedure after stillbirth 16 days before in the Philippines. She showed trismus, rigidity and muscle pain, but no muscle spasms, dyspnea and autonomic dysfunction. In this case, it is supposed that the obstetric procedure is the origin of the injury. In Japan, this is the first report of maternal tetanus.

[Tracheal intubation for two patients with lingual tonsil hyperplasia and prospect of difficult airway management].

Lingual tonsil hyperplasia is rare, but may cause difficult or inpossible tracheal intubation. We experienced two cases of tracheal intubation for lingual tonsil hyperplasia. A 71-yr-old man was scheduled for resection and biopsy of symptomatic hypertrophied lingual tonsils. In this patient, we performed oro-tracheal intubation by rigid laryngoscopy from left oral angle, because left hypertrophied lingual tonsils are smaller than those on the right side. A 44-yr-old man was scheduled for resection of symptomatic hypertrophied lingual tonsils after lingual tonsillitis. In this patient, we performed nasotracheal intubation using fiberoptic bronchoscopy with assist of jaw-lift and tongue-extension. When an anesthesiologist can predict the abnormality of lingual tonsils, these methods might be recommended for difficult airway and intubation. However, it is necessary to prepare a difficult airway management set including laryngeal mask airway, intubating laryngeal mask airway, fiberoptic bronchos-copy and transcutaneous tracheotomy set. And most important is preliminary evaluation of airway and cautious planning of tracheal intubation.

[Efficacy of active core rewarming using fluid heating system HOTLINE before and during the operation in a patient with for panperitonitis in state of shock and hypothermia].

A 62-year-old man was transported to the emergency room. He was in the state of shock and hypothermia of 34.2 degrees C. Fluid therapy was started using a HOTLINE to raise the body temperature, with vasopressors, vitamin B1 and sodium bicarbonate after checking arterial blood gas. Diagnosis of panperitonitis was made and operation was started immediately. We used HOTLINE before and during the operation. Body temperature returned to normal ranges, and hemodynamic state was stabilized at the end of the operation. After the operation, he received controlled artificial ventilation and nutrition support with intravenous hyperalimentation. Though he was complicated with disseminated intravascular coagulation, he went to general ward 17 days, and was discharged at 47 days after the operation. Sepsis accompanied with hypothermia leads to poor prognosis. We used fluid therapy with rapid-heating, and obtained good outcome. HOTLINE is effective for hypothermia in an emergency patient, because its effect is sure and does not obstruct the examination and management.

[A case of cor triatriatum diagnosed by echocardiography on pre-anesthetic examination].

A 69-year-old man was planned for elective surgery of the lumbar vertebral disk herniation. We performed a pre-anesthetic examination. He had a mild cardiomegaly (CTR = 55%) on chest X-ray examination, and ST-T change on electrocardiogram. His electrocardiogram showed negative T wave in III and aVF, ST elevation in I, aVL, V1-3, and flat T wave in V5-6. But he was without any symptoms of chest occlusion. He had no other abnormal laboratory data and abnormality in physical examination. We did echocardiography on him and cor triatriatum was diagnosed. The flow from the accessory chamber was 0.44 m.s-1. There were no abnormalities in the reflux of the pulmonary vein. We managed him under general anesthesia for operation, and took care to prevent right heart failure. There were no complications in peri-operative period. It was very important to perform pre-anesthetic examination by anesthetic specialist. Echocardiogram is useful for pre-anesthetic examination, if cardiovascular disease is suspected by chest symptom, electrocardiogram or chest X-ray examination.