A case of a neck injury penetrating to the oral cavity in a patient with intractable postoperative delirium associated with administration of multiple benzodiazepine agents (original) (raw)

2016, Japanese Journal of Oral and Maxillofacial Surgery

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A case of bilateral chylothorax after radical neck dissection

Journal of Japanese Society of Oral Oncology, 2017

Bilateral chylothorax is a rare complication of radical neck dissection. We experienced a case of bilateral chylothorax after neck dissection on the left side. A 54-year-old man with pain in the mandibular gingiva was referred to our hospital from a dental clinic on 28 th January 200X, and was diagnosed with squamous cell carcinoma of the left oral floor. Left radical neck dissection, right supraomohyoid neck dissection, marginal dissection of the left mandible, tumor resection of the left tongue and left oral floor, rectus abdominal free flap reconstruction, and tracheotomy were performed after preoperative chemoradiotherapy. On day 3 postoperatively, his oxygen saturation was remarkably decreased. Chest X-ray revealed bilateral pleural effusion. Pulmonary specialists were consulted and thoracic cavity drainage of the left side was performed. Biochemical analysis of the milky white effusion indicated bilateral chylothorax. On day 6 postoperatively, pleural effusion of the right thoracic cavity was increased, therefore a right thoracic drainage tube was inserted. A central venous catheter had been installed and total parenteral nutrition was initiated. Drainage from both sides of the chest decreased over the following week. As the volume of drainage fluid did not increase, the thoracic drainage tubes were removed 21 days after the operation. On day 22 postoperatively, medium-chain triglyceride diet was started. Over the five-year follow-up, the patient remains free from chylothorax.

Intravenous Patient-Controlled Analgesia in Acute Postoperative Pain Management

THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA, 2014

Good pain management after surgery is important to reduce complications associated with pulmonary and cardiac function and to promote earlier ambulation and faster recovery. In Japan, Patient-Controlled Analgesia (PCA) has been a widely accepted standard for acute pain management over the past decade. Intravenous PCA (IVPCA) is a popular choice because of its practicality, and it can also be used by patients who receive anticoagulant therapy during the perioperative period. However, the US Food and Drug Administration has reported adverse events involving PCA. These events were due to overdose of opioids due to misprescription, pump misprogramming, or device malfunction, all of which should be preventable by careful postoperative monitoring. To make it safer for patients to use PCA pumps, anesthesiologists, surgeons, nurses and medical engineers should cooperate and to enhance the safety of IVPCA. This article will review the basic concept of IVPCA and discuss multidisciplinary postoperative pain management and recent advances in acute postoperative pain management.

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