Masui. The Japanese journal of anesthesiology
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Patient-controlled sedation (PCS) using propofol under spinal anesthesia in transurethral lithotripsy was carried out in a 44 year old patient with von Gierke disease accompanied with liver dysfunction, chronic renal failure, hypoglycemia and metabolic acidosis. After administering spinal anesthesia PCS was started (0.2 mg.kg-1 intravenous bolus dose of propofol; infusion at 2 mg.kg-1.h-1; a three-minute lockout time interval following an initial doses of 0.4 mg.kg-1). ⋯ This patient was much satisfied with this sedation in an interview during the postoperative period. PCS using propofol is a useful method without respiratory depression for a patient with von Gierke disease.
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A 65-year-old female with pulmonary tuberculosis and systemic sarcoidosis developed sudden cardiac arrest after the use of bone cement in cementedendoprosthesis of the femoral head. Cardiac arrest was difficult to manage with ordinary CPR and PCPS was immediately instituted. ⋯ The patient required ventilatory support over next 7 days, but survived without neurological sequelae. When anesthetizing an elderly patient with preexisting cardiopulmonary disease for cementedendoprosthesis, PCPS should be considered in case of cardiac arrest due to the use of bone cement.
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Comparative Study
[A comparative study of transcranial Doppler sonography and near-infrared spectroscopy for the assessment of cerebrovascular CO2 reactivity].
Simultaneous measurements of time averaged mean blood flow velocity in the right middle cerebral artery (Vmca) by transcranial Doppler sonography (TCD) and regional cerebral oxygen saturation (rSo2) by near-infrared spectroscopy (NIRS) were performed in 30 subjects under propofol /fentanyl/ oxygen anesthesia. End-tidal CO2 pressure (PetCO2) was controlled by adjusting minute ventilation. A paired measurements of Vmca and rSo2 was repeated at PetCO2 of 50, 45, 40, 35, 30, and 25 mmHg in each subject. ⋯ There were significant linear correlations between PetCO2 and Vmca (R > 0.94, P < 0.01), between PetCO2 and rVmca (R > 0.94, P < 0.01), between PetCO2 and rSo2 (R > 0.92, P < 0.01), and between rSo2 and Vmca (R > 0.88, P < 0.05) in each subject. Furthermore, there was a significant linear correlation between rVmca based CO2 reactivity and rSo2 based CO2 reactivity (R = 0.60, P < 0.001). These results indicate that measurements of rSo2 may be an alternative method for evaluating cerebrovascular CO2 reactivity when poor ultrasound window.
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A 28-year old female schizophrenic patient underwent electroconvulsive therapy (ECT) under propofol anesthesia. She received ECT five times, and Bispectral Index (BIS) was recorded four times out of the five ECT. BIS values (mean +/- SD) were 95.3 +/- 1.3 before anesthesia, 38.0 +/- 13.1 after loss of consciousness, 45.3 +/- 12.7 immediately after ECT and 27.3 +/- 11.6 about two minutes after ECT. In conclusion, ECT may decrease BIS during continuous propofol infusion.
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We experienced a case of difficult tracheal intubation in a 15-year-old boy with von Recklinghausen disease scheduled for resection of a right neck tumor. His scoliosis made it difficult to intubate and to manage airway because he easily developed dyspnea. We tried nasotracheal intubation with the patient awake under sedation using a bronchofiberscope, but we found an unexpected tumor jeopardizing his airway patency near his vocal cord. Preoperative examination of a tumor in the airway is essential in the anesthetic management of the patients with von Recklinghausen disease.