ABSTRACT
OBJECTIVE: The purpose of this report was to examine whether peritoneal insufflation can facilitate CT-guided percutaneous jejunostomy replacement. CONCLUSION: Peritoneal insufflation allowed clear differentiation of the adherent jejunum from adjacent bowel, permitting confident direct puncture into the adherent jejunum without the need for jejunopexy anchors.
Subject(s)
Device Removal/methods , Enteral Nutrition/instrumentation , Jejunostomy/instrumentation , Pneumoradiography/methods , Radiography, Interventional/methods , Tomography, X-Ray Computed/methods , Aged , Female , Humans , Male , Middle Aged , Peritoneum/diagnostic imaging , Treatment OutcomeABSTRACT
BACKGROUND: Methamphetamine abuse is a serious public health concern and causes various life-threatening disorders including pulmonary arterial hypertension (PAH). Herein, we present the first case report describing the anesthetic management of a patient with methamphetamine-associated PAH (M-A PAH) undergoing laparoscopic cholecystectomy. CASE PRESENTATION: A 34-year-old female with M-A PAH suffered from deterioration of right ventricular (RV) heart failure due to recurrent cholecystitis and was scheduled for laparoscopic cholecystectomy. Preoperative assessment of PA pressure showed 82/32 (mean, 50) mmHg, and transthoracic echocardiology revealed a slight reduction of RV function. General anesthesia was induced and maintained by thiopental, remifentanil, sevoflurane, and rocuronium. PA pressure gradually increased after peritoneal insufflation; therefore, we administered dobutamine and nitroglycerin to decrease pulmonary vascular resistance (PVR). The patient emerged from anesthesia smoothly. CONCLUSIONS: Avoiding increased PVR by appropriate anesthesia and medical hemodynamic support is an important consideration for patients with M-A PAH.
ABSTRACT
PURPOSE: To investigate the ventilatory effect of laparoscopic cholecystectomy in patients under general anesthesia with epidural block. METHODS: We measured arterial blood gas, pulmonary carbon dioxide elimination (0000126;ECO2), the dead space/tidal volume ratio (VD/VT), and the alveolar-arterial PO2 difference [(A-a)DO2] just before and 5, 10, 20, 40, and 80 min after peritoneal insufflation in eight patients who underwent laparoscopic cholecystectomy under general anesthesia with epidural block. The effect of laparoscopic cholecystectomy on these values was evaluated. The patients were ventilated on the controlled mode by Servo 900C with a constant tidal volume (VT 10ml·kg-1) and frequency (respiratory rate 12 breaths·min-1) throughout the study. RESULTS: After starting peritoneal insufflation the PaCO2 showed a sudden increase during the initial 10 min of about 4 mmHg followed by a gradual increase thereafter. The increase in000123;ECO2 was about 30ml·min-1 (20%) on average during the initial 20 min, and a plateau was reached within 20-40 min after peritoneal insufflation. Neither VD/VT nor (A-a)DO2 showed significant changes during the study. CONCLUSION: These results suggest that (1) transperitoneal absorption of CO2 may be the main cause of hypercarbia, and the hypercarbia is not attributed to the increase in VD/VT; and (2) oxygenation is not impaired during pneumoperitoneum.