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Nakamura H, Hisago S, Ishitsuka S. The lumbar subcutaneous fat gradient in spinal anesthesia seen for morbidly obese patient with pre-procedure ultrasonography - A case report. Saudi J Anaesth 2023; 17:110-112. [PMID: 37032699 PMCID: PMC10077796 DOI: 10.4103/sja.sja_562_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 12/24/2022] Open
Abstract
It has been reported that pre-procedure ultrasonography rises the success rate of spinal anesthesia in obese patients. In this article, we performed spinal anesthesia for morbidly obese patient with pre-procedure ultrasonography. And recognizing the lumbar subcutaneous fat gradient in morbidly obese patient was the key to success. A cesarean section was scheduled for a primigravida in her 30 s with BMI 61 kg/m2. The lumbar spine was not palpable. Pre-procedure ultrasonography revealed lumbar subcutaneous tissue getting thicker caudally in the sagittal view. Considering this fact, we adjusted the puncture site and succeeded. Postoperative complications were not observed. The pre-procedure ultrasonography is effective even in morbidly obese patients. It is important to recognize the lumbar subcutaneous fat gradient, the so-called back fat slope, for spinal anesthesia in obese patients.
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Affiliation(s)
- Hiroki Nakamura
- Department of Anesthesiology, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Shuhei Hisago
- Department of Anesthesiology, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Shunsuke Ishitsuka
- Department of Anesthesiology, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
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Koyama Y, Inoue Y, Hisago S, Marushima A, Hagiya K, Yamasaki Y, Enomoto Y, Shimojo N, Kawano S, Mizutani T. Improving the neurological prognosis following OHCA using real-time evaluation of cerebral tissue oxygenation. Am J Emerg Med 2017; 36:344.e5-344.e7. [PMID: 29157790 DOI: 10.1016/j.ajem.2017.11.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 11/13/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The neurological prognosis is poor for patients suffering from out-of-hospital cardiac arrest (OHCA), in the absence of bystander cardio pulmonary resuscitation (CPR), and showing asystole as the initial waveform. However, such patients have the potential of resuming social activity if cerebral tissue oxygen saturation can be preserved. CASE PRESENTATION We recently encountered a 60-year-old man who had suffered an OHCA in the absence of bystander CPR, and who successfully resumed complete social activity despite initial asystole and requiring at least 75min of chest compressions before return of spontaneous circulation (ROSC). In this case, chest compression was appropriately performed concurrently with real-time evaluation of cerebral tissue oxygenation using near-infrared spectroscopy (NIRS). As a result, the cerebral tissue oxygenation was well maintained, leading to resumption of social activity. CONCLUSIONS Improved neurological prognoses can be expected if OHCA patients with the potential for social activity resumption are identified, using NIRS, and effective cardiopulmonary and cerebral resuscitation is performed while visually checking CPR quality.
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Affiliation(s)
- Yasuaki Koyama
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan.
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan.
| | - Shuhei Hisago
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Aiki Marushima
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan.
| | - Keiichi Hagiya
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Yuichiro Yamasaki
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Yuki Enomoto
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan.
| | - Nobutake Shimojo
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Satoru Kawano
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan.
| | - Taro Mizutani
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan.
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