[Case of facial nerve palsy accompanied with swelling of the parotid gland following the surgery with left lateral decubitus position].

A 70-year-old woman (142 cm in height, 75 kg in weight, BMI 37) received right total hip arthroplasty in the left lateral decubitus position. The operation time was 9 and a half hours. The morning after the operation, erythema accompanied with bullae was observed on the skin of the left parotid gland and left shoulder, and left facial nerve palsy developed. The palsy was almost paralysis with marked facial asymmetry and severe blepharoptosis. Ultrasonography showed diffuse swelling of the left parotid gland. The serum amylase level was 642 IU . l-1 (normal range : 40-113). Prolonged parotid gland compression during the operation would have caused acute swelling of the parotid gland and facial nerve palsy. The palsy resolved completely after 5 months.

[Anesthetic management of a patient with severe combined pulmonary disease under epidural anesthesia with spontaneous respiration].

A 74-year-old man with gastric cancer was complicated with abdominal aortic aneurysm. A two-stage operation was scheduled (repair of abdominal aortic aneurysm and subsequent gastrectomy). He also had severe chronic obstructive pulmonary disease (COPD). We planned to maintain spontaneous breathing during operations under epidural anesthesia and light general anesthesia. For the first surgery, two epidural catheters were placed at T1-2 and T7-8 on the day before surgery. After establishing epidural anesthesia, general anesthesia was induced and maintained with midazolam, fentanyl and sevoflurane, but without muscle relaxants under BIS monitoring. Ropivacaine solution 0.375% was infused through an epidural catheter to provide analgesia, and spontaneous breathing was kept throughout the procedure. Surgery lasted 4 hours and 50 minutes, and patient recovered without complications. Forty days after the first surgery, the second operation was scheduled. Anesthetic management was almost the same as in the first one, except for the use of dexmedetomizine rather than sevoflurane. In both operations, sufficient analgesia was provided with epidural anesthesia, and the surgeons rated muscle relaxation as satisfactory. No respiratory complications developed postoperatively. Maintaining spontaneous breathing during abdominal surgery using epidural anesthesia and light general anesthesia is a good option for COPD patients.

[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.

[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.