Masui. The Japanese journal of anesthesiology
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We experienced anesthetic management of a 45-yr-old female patient with a 12-yr history of multiple sclerosis who underwent orthopedic surgeries three times under general anesthesia. We chose rapid induction with propofol and maintained the anesthesia with nitrous oxide, oxygen, and sevoflurane. ⋯ There is no other report of anesthesia using propofol as induction agent for a patient with multiple sclerosis. We succeeded in the satisfactory perioperative management of the patient.
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Case Reports
[Anesthetic management of a patient with hypertrophic cardiomyopathy using propofol, fentanyl and ketamine].
A 59-year-old male with hypertrophic cardiomyopathy was scheduled for resection of a maxillary cyst. Metoprolol was discontinued the day before surgery. Thirty min before anesthesia, meperidine 35 mg was administered intramuscularly. ⋯ However, BP, PA, SVRI and PVRI increased temporally at extubation. His postoperative course was uneventful. In conclusion, total intravenous anesthesia with propofol, fentanyl and ketamine may be useful for anesthetic management of a patient with hypertrophic cardiomyopathy.
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Case Reports
[Evaluation of epidural blood patch in the treatment of two cases of spontaneous intracranial hypotension].
We evaluated the effect of epidural blood patch (EBP) in the treatment of two cases of spontaneous intracranial hypotension (SIH). Both case 1 (53-year old female) and case 2 (44-year old female) had severe postural headache and showed meningeal thickening by cranial MRI, and were diagnosed as SIH. Case 1: Although her intracranial pressure remained within normal ranges, an extradural leakage was shown in the middle thoracic region on isotope cisternography using indium-111 labeled DTPA. ⋯ Case 2: Her intracranial pressure was low (0 mmH2O on supine position), but, isotope cisternography using DTPA showed only the early appearance of isotope in the bladder but failed to disclose the site of the CSF leak. Epidural blood patch with 30 ml of autologous blood was performed at Th 12-L 1 level which only resulted in severe backache without clinical improvement. In conclusion, we could not find the effectiveness of EBP on the two cases of SIH, although there are many reports on its efficacy.
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Case Reports
[Epidural anesthesia for cesarean section in a twin pregnant patient with severe aortic stenosis].
A 35-year-old twin primigravida with aortic stenosis underwent cesarean section under epidural anesthesia. She had her ventricular septal defect repaired at 3 years of age. Preoperative ultrasonic study revealed severe aortic stenosis in which valve area was 0.77 cm2 and pressure gradient between the left ventricle and the aorta was 80 mmHg. ⋯ Otherwise, peripartal hemodynamics was stable, and she was transferred to the intensive care unit (ICU). Postoperative pain was controlled with epidural infusion of fentanyl. She did not complain of chest pain perioperatively and was discharged from the ICU next day.