[Combined General and Spinal-Epidural Anesthesia under Spontaneous Breathing in a Patient with a Giant Bulla].

This paper reports the successful perioperative management of a patient with a giant bulla, who underwent radical prostatectomy under general anesthesia performed under combinet spinal-epidural anesthesia while maintaining spontaneous respiration. A 61-year-old man was scheduled for radical prostatectomy. He had undergone conservative treatment using a drainage tube for right-sided pneumothorax at the age of 23. Preoperative chest CT revealed the presence of a giant bulla in the left upper lobe, multiple bullae in the entire right lung, and emphysematous alterations in both lungs. On respiratory function testing, mild obstructive impairment was observed. In the operating room, an epidural catheter was inserted at T11-12, and spinal anesthesia was performed at L3-4. Under anesthesia with propofol and fentanyl, i-gel® was inserted. During anesthesia, spontaneous respiration was managed at oxygen concentration 40% and sevoflurane 1.5%, while continuing the epidural administration of levobupivacaine. The circulatory and respiratory conditions were stable during surgery. The durations of surgical and anesthetic procedures were 2 hours and 16 minutes and 3 hours and 33 minutes, respectively. In the absence of respiratory complications, the patient was discharged 8 days after surgery.

[A retrospective study in spinal anesthesia for sumo-wrestlers].

BACKGROUND: Spinal anesthesia for the Sumo-wrestler is thought to be difficult because of following reasons. 1. Sumo-wrestlers are so fatty and weighty that piercing spinal needle into the subarachnoid space is technically difficult. 2. The relationship between volume of local anesthetics and attained spinal anesthesia level is difficult to detect. 3. Upper airway can be easily obstructed during sedation. METHODS: Retrospectively, we compared 30 Sumo-wrestler patients (group S) with normal body weight patients (group N) concerning 17 items. RESULTS: While all patients in group N were approached from L 3 and L 4 interspinal space using 25 gauge spinal needles, 13 patients in group S were approached from another interspinal space, for example L 2 and L 3 or L 4 and L 5 and 40% of patients in group S needed 23 gauge spinal needles. The time intervals from the entrance into the operating room till the end of intrathecal administration of local anesthetics in group S and group N were 34 and 24 minutes, respectively (P < 0.05). The distances from the surface of the skin to subarachnoid space in group S and group N were 80 mm and 49 mm, respectively (P < 0.05). CONCLUSIONS: These results indicate that subarachnoid puncture in Sumo-wrestler patients is difficult and we should understand the specificities of spinal anesthesia for these patients.