This case report discusses the effective use of spinal cord stimulation (SCS) to treat lower limb pain caused by conus medullaris syndrome. A 49-year-old woman presented with persistent right lower limb pain and numbness following laparoscopic colon resection surgery. During epidural anesthesia, she experienced electric shock-like pain, which continued after surgery. MRI revealed fluid around the T12 thoracic spinal cord, suggesting spinal injury. Despite initial treatments, including epidural and nerve root blocks, the pain persisted. Further intervention with SCS led to significant pain reduction and improved mobility, enabling the patient to engage in rehabilitation. Conus medullaris syndrome, typically involving the T11-T12 to L2 spinal cord levels, can cause varied symptoms, including muscle weakness, atrophy, and radicular pain. In this case, the injury at the T11-T12 level presented with pain localized to the L2-L3 nerve root area, complicating the diagnosis. SCS, known for its efficacy in managing neuropathic pain, proved to be a suitable treatment for this patient, whose pain was refractory to conservative therapies. The treatment led to sustained pain relief and facilitated rehabilitation. This case highlights the diagnostic difficulties associated with conus medullaris syndrome; the symptoms of this condition may be similar to those of other conditions such as spinal pain. In this case, SCS was highly effective in treating neuropathic pain associated with spinal cord injury. In conclusion, SCS therapy provides significant relief for patients with conus medullaris syndrome, underscoring its importance in the management of chronic intractable neuropathic pain.

BACKGROUND: Epiglottic masses are often asymptomatic, making them difficult to detect during preoperative examinations. Consequently, anesthesiologists may face ventilation difficulties with no apparent cause. Epiglottic masses can sometimes obstruct laryngoscope insertion into the epiglottic vallecula, complicating general anesthesia induction. In such cases, supraglottic airway insertion may be a viable alternative; however, the limited case reports on its use for epiglottic masses make its applicability unclear. Therefore, we test the hypothesis that a larger laryngeal artificial mass could obstruct the view of the larynx, even when supraglottic airways are used in a mannequin study. METHODS: We utilized an airway management simulator (Air Sim Multi®: Nihon 3B Scientific, Japan) to place various sizes of artificial masses (tumors) above the epiglottis. The groups included a control group with no mass, small size mass group, middle size mass group, and large size mass group. The supraglottic airway (i-gel®: Intersurgical, UK) was then inserted 10 times. We categorized the view of the vocal cords using a bronchoscope inserted through the tip of the cuff according to the Cormack-Lehane classification. In addition, we performed pressure-controlled ventilation, adjusting the inspiratory pressure from 10 cm H₂O to 25 cm H₂O, while measuring the tidal volumes. RESULTS: The Cormack-Lehane classification grade increased in correlation with the mass size. In each inspiratory pressure, tidal volume decreased in correlation with the mass size. Furthermore, in the large-size mass group, even at an inspiratory pressure of 25 cm H₂O, achieving the tidal volume required for general adult respiratory management was deemed difficult. CONCLUSION: In a mannequin study, we observed that epiglottic masses significantly increased the Cormack-Lehane classification grade and reduced tidal volume, with these effects correlating with the size of the mass. This finding suggests that the appropriateness of using a supraglottic airway may depend on the size and weight of the epiglottic mass.

96歳女。人工骨頭置換術の術前に病棟でグリセリン浣腸を施行された直後から3時間以上に及ぶ意識障害をきたし、回復後に後遺症はなかった。意識障害をきたした原因として、浣腸を契機に血管迷走神経反射が起こり、その際の血圧低下に伴い、全脳あるいは椎骨脳底動脈系の血流不全が生じた可能性が推測された。後遺障害なく回復した理由については、血流低下の時間や程度が限定的であったために、不可逆的な低酸素性虚血性脳障害に至らなかったのではないかと思われた。本例のような「96歳、体重33kg」の患者に60mlのグリセリン浣腸を一律に実施することの適否は慎重に判断する必要があると思われた。