> 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

Epidural Analgesia for Labor and Delivery

NEJM Volume 362:1503-1510; 2010

Ultrasound-Guided Internal Jugular Vein Cannulation

NEJM Volume 362:e57; 2010

Utility of the ProSeal laryngeal mask airway creating a 90° angle with an intubating stylet

J Anesth.

俺はこれは嫌いだな。

これはいいよ

The intravenous anesthetic propofol inhibits lipopolysaccharide-induced hypoxia-inducible factor 1 activation and suppresses the glucose metabolism in macrophages

適当な購読権は必要なようです。