[Anesthetic management for gastrojejunostomy in a patient with hemiplegia and recurrent laryngeal nerve palsy].
A 70-year-old man who had undergone a low anterior resection for primary rectal cancer 9 years before complained of anorexia, hemiplegia, and recurrent laryngeal nerve palsy. The anorexia was caused by duodenal stenosis due to swollen lymph nodes, the hemiplegia was caused by a metastatic brain tumor, and the recurrent laryngeal nerve palsy was caused by metastases of the cancer to the mediastinal space. Metastases were also found in the bilateral lungs, liver, ureter, and cervical vertebra. In choosing the anesthesia for the gastrojejunostomy to improve the malnutrition of this patient, we decided, on the basis of the patient's full stomach, malnutrition, hypovolemia, hemiplegia, cerebral compression, recurrent laryngeal nerve palsy, renal dysfunction, and respiratory dysfunction, to use thoracic epidural anesthesia rather than spinal anesthesia or general anesthesia. Thoracic epidural anesthesia could provide sufficient analgesia, and the operation was uneventful. In anesthetic management of an end-stage patient undergoing a palliative operation like this, we should consider the purpose of the operation, its complications, and further complications which may be induced by anesthesia in order to plan out an anesthetic regimen unlikely to lead to harmful events in perioperative period.
Saijo
H
H
Department of Oral Surgery and Department of Anesthesiology, The University of Tokyo Branch Hospital, Tokyo 112-8688.
Kitamura
T
T
Fujiwara
H
H
Nagata
O
O
Hagiwara-Oguchi
K
K
Ide
Y
Y
Tagami
M
M
Hanaoka
K
K
D000368:Aged; D000767:Anesthesia, Epidural / Q000379:methods*; D005774:Gastrostomy; D006429:Hemiplegia / Q000150:complications*; D006801:Humans; D007582:Jejunostomy; D008297:Male; D009748:Nutrition Disorders / Q000150:complications; D010166:Palliative Care; D012009:Recurrent Laryngeal Nerve; D014826:Vocal Cord Paralysis / Q000150:complications*