Vallecular cysts are rarely seen in adults and occur as a result of the tongue base mucus retenti... more Vallecular cysts are rarely seen in adults and occur as a result of the tongue base mucus retention. In cases with laryngeal inlet obstruction due to a vallecular cyst, the airway management sometimes might be a challenge. We presented the airway management of an adult patient with difficult airway due to a large vallecular cyst. A 28-year-old male patient with a large vallecular cyst was scheduled for surgical excision of the cyst under general anesthesia. Despite the use of different laryngoscopic blades, no laryngeal structure was seen due to the cystic formation. After aspiration of approximately 20 mL cyst content, the peripheral side of the epiglottis was seen on the left-upper side of the shrunken cyst. Therefore, laryngoscopy was performed by an insertion of the left side of the mouth, and tracheal intubation was achieved by endotracheal tube which was advanced blindly under the epiglottis. A week later, due to cyst reoccurrence, the patient was undergone surgery again. No problem arose during the course of anesthesia, surgical intervention and the postoperative period, and the patient was discharged on the fifth postoperative day. We concluded that the view of the glottis or other laryngeal structures can be obtained by shrinking the vallecular cyst size.
International Journal of Obstetric Anesthesia, 2014
Background: Following maternal administration, local anesthetics pass into breast milk. In the pr... more Background: Following maternal administration, local anesthetics pass into breast milk. In the present study, we aimed to compare the passage of levobupivacaine and bupivacaine into breast milk following epidural anesthesia for cesarean delivery. Methods: A total of 20 women undergoing elective cesarean delivery under epidural anesthesia were randomized to receive either 0.5% levobupivacaine or 0.5% racemic bupivacaine via an epidural catheter. Immediately before and 30 min, 1 h, 2 h, 6 h, 12 h and 24 h after administration of epidural local anesthetic, maternal blood and breast milk samples were taken simultaneously. Drug concentrations in plasma and milk were determined via high-performance liquid chromatography. The infant's drug exposure was determined by calculating milk/plasma ratios of levobupivacaine and bupivacaine. Results: Both levobupivacaine and bupivacaine were detected in breast milk 30 min after epidural administration. Concentrations of both agents showed constant and similar decreases in milk and plasma and were nearly undetectable at 24 h. The milk/plasma ratios were 0.34 ± 0.13 for levobupivacaine and 0.37 ± 0.14 for bupivacaine. Conclusions: Both levobupivacaine and bupivacaine pass into breast milk following epidural administration. The concentration of both drugs was approximately three times lower in breast milk than in maternal plasma.
Vallecular cysts are rarely seen in adults and occur as a result of the tongue base mucus retenti... more Vallecular cysts are rarely seen in adults and occur as a result of the tongue base mucus retention. In cases with laryngeal inlet obstruction due to a vallecular cyst, the airway management sometimes might be a challenge. We presented the airway management of an adult patient with difficult airway due to a large vallecular cyst. A 28-year-old male patient with a large vallecular cyst was scheduled for surgical excision of the cyst under general anesthesia. Despite the use of different laryngoscopic blades, no laryngeal structure was seen due to the cystic formation. After aspiration of approximately 20 mL cyst content, the peripheral side of the epiglottis was seen on the left-upper side of the shrunken cyst. Therefore, laryngoscopy was performed by an insertion of the left side of the mouth, and tracheal intubation was achieved by endotracheal tube which was advanced blindly under the epiglottis. A week later, due to cyst reoccurrence, the patient was undergone surgery again. No problem arose during the course of anesthesia, surgical intervention and the postoperative period, and the patient was discharged on the fifth postoperative day. We concluded that the view of the glottis or other laryngeal structures can be obtained by shrinking the vallecular cyst size.
International Journal of Obstetric Anesthesia, 2014
Background: Following maternal administration, local anesthetics pass into breast milk. In the pr... more Background: Following maternal administration, local anesthetics pass into breast milk. In the present study, we aimed to compare the passage of levobupivacaine and bupivacaine into breast milk following epidural anesthesia for cesarean delivery. Methods: A total of 20 women undergoing elective cesarean delivery under epidural anesthesia were randomized to receive either 0.5% levobupivacaine or 0.5% racemic bupivacaine via an epidural catheter. Immediately before and 30 min, 1 h, 2 h, 6 h, 12 h and 24 h after administration of epidural local anesthetic, maternal blood and breast milk samples were taken simultaneously. Drug concentrations in plasma and milk were determined via high-performance liquid chromatography. The infant's drug exposure was determined by calculating milk/plasma ratios of levobupivacaine and bupivacaine. Results: Both levobupivacaine and bupivacaine were detected in breast milk 30 min after epidural administration. Concentrations of both agents showed constant and similar decreases in milk and plasma and were nearly undetectable at 24 h. The milk/plasma ratios were 0.34 ± 0.13 for levobupivacaine and 0.37 ± 0.14 for bupivacaine. Conclusions: Both levobupivacaine and bupivacaine pass into breast milk following epidural administration. The concentration of both drugs was approximately three times lower in breast milk than in maternal plasma.
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