> Macroglossia is defined as an abnormal enlargement of the tongue that predominantly affects pediatric patients and is not frequent in adult patients. Hypothyroidism and hyperpituitarism may cause macroglossia in adults. In addition, infiltration of the tongue by abnormal tissues, including angiomatous and lymphatic malformations and amyloidosis, is a major cause of macroglossia, particularly in adults.
Here we describe the case of a 63-year-old male patient with massive macroglossia due to tongue hemangioma who underwent laser ablation under general anesthesia. Elaborate preanesthetic anatomical and functional airway evaluation facilitated successful airway management in this patient, even in the presence of massive macroglossia.

最終的には結構短くなったのでどこかで機会を見つけて長いバージョンを世に出してみたいと思います。

Ectopic ACTH syndrome revealed as severe hypokalemia and persistent hypertension during the perioperative period: a case report

Abstract

Both severe hypokalemia and persistent hypertension are clinical symptoms of hyperaldosteronism. Hyperaldosteronism may occur as primary or secondary syndromes. Excess ACTH produced ectopically by tumors may induce hyperaldosteronism through the mineralocorticoid activity of glucocorticoids that are upregulated by ACTH. Licorice, with the active ingredient glycyrrhiza, is also a well known inducer of hyperaldosteronism under specific conditions.
In this report, we describe a case of severe hypokalemia due to ectopic ACTH syndrome (EAS) elicited by an intrathoracic carcinoid tumor, which transformed to produce ACTH during the 6 year clinical course, and was modulated by licorice ingestion. Hypokalemia was not clearly recognized preoperatively, but became obvious within the 3 hours of general anesthesia with epidural blockade. At the end of anethesia, arterial blood gas analysis indicated severe hypokalemia ([K+]=1.7 mEq/L) and metabolic alkalosis (pH=7.56, PaCO2=54.9 mmHg, HCO3-=44.5 mmol/L, BE=21.8mmol/L) without any typical symptoms, such as muscle weakness or ECG abnormalities. The hypokalemia was resistant to potassium supplmentation and persisted for 4 days. Periopetative inbalance between the administration and elimination of potassium and surgical stress might contribute to the rapid exaggeration or induce the clinical manifestation of EAS.

Journal of Anesthesia, in press

Pituitary apoplexy during general anesthesia in beach chair position for shoulder joint arthroplasty

Tokito Koga, Mariko Miyao, Masami Sato, Kiichi Hirota, Masahiro Kakuyama , Hiroko Tanabe, Kazuhiko Fukuda
Journal of Anesthesia

Abstract

Pituitary apoplexy (PA) is a rare but potentially life-threatening clinical syndrome caused by the sudden enlargement of pituitary adenoma secondary to infarction and/or hemorrhage. It may be the first presentation of previously undiagnosed pituitary adenoma. Although various precipitating factors of pituitary apoplexy are indicated, the pathogenesis remains to be known. In this report, we describe for the first time a case of pituitary apoplexy developed explicitly during general anesthesia supplemented with interscalene brachial plexus block in beach chair or barbershop position for shoulder joint arthroplasty.

Key Words; pituitary apoplexy, beach chair position, complication, interscalene brachial plexus block

Successful airway management with use of a laryngeal mask airway in a patient with CHARGE syndrome.

Hara Y, Hirota K, Fukuda K.

J Anesth. 2009 Nov;23(4):630-632. Epub 2009 Nov 18.

Death from Propofol: Accident, Suicide, or Murder?

Anesth Analg 2009; 108:1182-1184
doi: 10.1213/ane.0b013e318198d45e

A 24-yr-old woman was found dead in her home from apparent propofol “toxicity.” Her blood level of propofol was 4.3 µg/mL. She had no history of drug abuse and no evidence of such behavior at autopsy. The medical examiner and police investigators felt that she died from probable homicide. Attention was focused on a male registered nurse acquaintance, who had acquired propofol and other drugs in the course of his regular duties in a surgical intensive care unit. This is the first reported case of murder with propofol.

このほかにpropofol関連死の報告が14例のっています。