A 25-year old female singer was scheduled to undergo a right hepatectomy for her father's liver transplantation. Her two main requests were rapid recovery and prevention of cosmetic complications, and the avoidance of postoperative laryngeal damage. Thus, we decided to use a laparoscopic surgical approach and the second-generation supraglottic airway (Protector™ supraglottic airway). After anesthetic induction, the supraglottic airway was placed at the first attempt, and its performance was tested using the oropharyngeal leak pressure and maximal minute volume ventilation tests. Throughout the surgery, the cuff pressure of the supraglottic airway was maintained in the green zone. The Protector™ supraglottic airway was successfully used during 300 minutes of anesthesia, and it only caused mild postoperative sore throat without hoarseness or aspiration. Anesthesiologists should consider using the supraglottic airway proactively in laparoscopic living donor right hepatectomies when professional voice users undergo surgery.
Anesthesia ; Female ; Hepatectomy* ; Hoarseness ; Humans ; Laparoscopy ; Laryngeal Masks ; Liver Transplantation ; Living Donors* ; Pharyngitis ; Pulmonary Ventilation ; Singing* ; Voice

Background: Although programmed intermittent epidural bolus (PIEB) is effective for labor analgesia, an appropriate flow rate has not been established. Therefore, we investigated the analgesic effect based on different epidural injection flow rates. Methods: Nulliparous women scheduled for spontaneous labor were enrolled in this randomized trial. After injection of intrathecal 0.2% ropivacaine 3 mg with fentanyl 20 μg, participants were randomized to three study groups. Epidural analgesics, 10 ml during one hour, were administered with patient controlled epidural analgesia as follows (0.2% ropivacaine 60 ml, fentanyl 180 μg, and 0.9% saline 40 ml): continuous (n = 28, 10 ml/h for continuous infusion), PIEB (n = 29, 240 ml/h for bolus infusion of 10 ml), or manual (n = 28, 1200 ml/h for bolus injection of 10 ml). The primary outcome was hourly consumption of the epidural solution. The time interval between labor analgesia and the first breakthrough pain was investigated. Results: The median (Q1, Q3) hourly consumption of epidural anesthetics was significantly different among the groups (continuous: 14.3 [8.7, 16.9] ml, PIEB: 9.4 [6.2, 9.8] ml, manual: 8.6 [7.6, 9.9] ml; P < 0.001). The time to breakthrough pain for the PIEB group was longer than that for the other groups (continuous: 78.5 [35.8, 185.0] min, PIEB: 200.0 [88.5, 441.5] min, manual: 60.5 [37.3, 162.0] min, P = 0.027). Conclusions PIEB, with a low-flow rate, provided more adequate labor analgesia than a continuous epidural infusion or manual injection with a high-flow rate.