title: [Interscalene block combined with general anesthesia under spontaneous breathing in a patient with a giant bulla].
abstract: Respiratory management for patients with a giant bulla during anesthesia should avoid positive-pressure ventilation to reduce the risk of barotraumas. We report a case of anesthetic management of a 42-year-old man with a giant bulla who had an elective surgery for biopsy of a tumor on his left elbow. Balanced anesthesia consisting of general anesthesia was given under spontaneous breathing combined with interscalene brachial plexus blockade for intra- and postoperative analgesia for the elbow surgery. The patient was monitored by electrocardiography, non-invasive arterial pressure, SpO2, endtidal CO2 tension and bispectral index. Ultrasound-guided interscalene block was performed with the patient awake. After injection of 0.75% ropivacaine 20 ml and 1% lidocaine 16 ml for brachial plexus block, general anesthesia was induced with a bolus of fentanyl 100 microg to reduce cough reflex and propofol using target control infusion with a 2 microg x ml(-1) plasma concentration. The airway was maintained with a size 4 LMA-Proseal, which was inserted with care under spontaneous breathing. There were no serious complications such as pneumothorax in perioperative period. We performed successful anesthetic management, without any complications, combined with interscalene brachial plexus block and spontaneous breathing in a patient with a giant bulla.
authors.affiliation: Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sugiura
authors.forename: Rumiko
authors.initials: R
authors.lastname: Akiyoshi
authors.forename: Rina
authors.initials: R
authors.lastname: Kato
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sasano
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sobue
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods*; D001768:Blister / Q000150:complications*; D001917:Brachial Plexus; D004550:Elbow; D006801:Humans; D008171:Lung Diseases / Q000150:complications*; D008297:Male; D009407:Nerve Block; D012119:Respiration; D012983:Soft Tissue Neoplasms / Q000601:surgery