Preemptive submucosal infiltration with 0.33% ropivacaine effectively controlled pain after uvulopalato-pharyngoplasty.

Rationale:The main complication of patients with severe hemophilia is recurrent bleeding events that usually affected musculoskeletal contractures. And replacement therapy methods were continuously improved to minimize adverse impacts brought by those complications. However, only several cases reported about the appendectomy for hemophilia A. We report a case of acute appendicitis treated by two-incision laparoscopy in a boy with hemophilia A and coagulation factor VII deficiency for the first time.Patient concerns:An 8y7m-old Chinese boy presented with half a day of right sided abdominal pain, fever, nausea, and vomiting.Diagnoses:He received a computed tomography (CT) scan which revealed an enlarged appendix, thickened wall and appendiceal fecalith, and had received a conservative anti-bacterial treatment for his acute appendicitis but failed. He was diagnosed with hemophilia A and coagulation factor VII deficiency.Interventions:Two-incision laparoscopic appendectomy was made in success with a careful management of perioperative period. We monitored the clotting factor FVIII level and gave him a replacement therapy.Outcomes:The patient had an uneventful recovery.Lessons:It is important to exclude intraabdominal or retroperitoneal hemorrhage in patients suffering from hemophilia and acute abdominal pain. Pre-operative evaluation of validity of the FVIII replacement therapy is another effective strategy to assess the safety and feasibility of applying an operation procedure. The two-incision laparoscopic appendectomy is an effective treatment for this kind of patients for its minimal trauma and fast recovery characteristics. Our report shows that laparoscopic appendectomy is feasible in a child suffering from hemophilia after adequate blood clotting factor replacement treatment.

Objective: To evaluate the efficiency of ventilation using a novel chin-lift mask compared with an oropharyngeal airway (OPA) with EC-clamp technique in obese patients. Methods: Obese patients scheduled for cholecystectomy under general anaesthesia were divided into two groups: the OPA group, in which a standard mask and OPA with the EC-clamp technique were used; the CL group, in which the chin-lift mask was used. Respiratory data were compared. Results: One hundred patients were recruited and assigned to the OPA (n ¼ 50) and CL (n ¼ 50) groups. Compared with the OPA group, expired tidal volume, peripheral oxygen saturation (S p O 2 ), tidal volume/peak inspiratory pressure ratio and end-tidal carbon dioxide were higher, and the peak and mean inspiratory pressures were lower, in the CL group. In the CL group, no patient had an S p O 2 95% and the lowest S p O 2 was 99%, whereas in the OPA group, 23 patients had an S p O 2 95% and the lowest S p O 2 was 92%. Difficult mask ventilation occurred in eight patients in the OPA group but in none in the CL group. Conclusion: The chin-lift mask provided a patent airway and better quality mask ventilation than an OPA with EC-clamp technique in obese patients.

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