Masui. The Japanese journal of anesthesiology
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Case Reports
[Anesthetic management of a hyper-obese patient by target-controlled infusion (TCI) of propofol and fentanyl].
We gave total intravenous anesthesia to an over-100% hyper-obese patient using target-controlled infusion (TCI) of propofol and fentanyl. To keep him asleep, we maintained his BIS in a range of 40 to 60 by adjusting the target concentration of propofol. ⋯ The relationship between BIS value and effect-site concentration of propofol was almost the same as that assessed in ordinary adults of a normal weight. We conclude that the estimated concentration of propofol is a good indicator of the effect of propofol and that TCI is a useful technique in obese patients as well as in ordinary adults.
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We present a case of a 46-year-old female patient with systemic lupus erythematosus who developed herpes zoster of the right eighth cervical nerve. Her whole right forearm, hand and the first through fifth fingers were coated with some gel and protected against pain. ⋯ Reduction of pain and edema as well as improvement in mobility of each joint of her right upper extremity was observed. We suspect that SGB, continuous cervical epidural block and ulnar nerve block are effective and useful alternative treatments in a patient with PHN associated with CRPS of the eighth cervical nerve.
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Comparative Study
[Propofol Concentration during Maintenance of and Emergence from Propofol/Epidural Anesthesia: Comparison between Younger and Elderly Patient].
To investigate the influence of patient age on the sensitivity to propofol, we measured blood propofol concentrations in ten elderly (over 70 years of age) and ten younger (under 60 years of age) patients undergoing elective abdominal surgery during propofol/epidural anesthesia. Bispectral index (BIS) was continuously recorded for monitoring anesthetic effect, and the infusion rate of propofol was controlled to keep BIS at 50 after the induction of anesthesia with propofol. ⋯ Mean blood propofol concentrations were 4.0 +/- 1.5 micrograms.ml-1 for the younger group and 3.2 +/- 1.7 micrograms.ml-1 for the elderly group at the end of surgery immediately before discontinuation of propofol, and they were 1.9 +/- 0.7 micrograms.ml-1 (BIS = 86 +/- 7) for the younger group and 1.5 +/- 0.8 micrograms.ml-1 (BIS = 84 +/- 3) for the elderly group at the time of eye opening with no significant difference. We found appreciable individual variations in the propofol concentrations both in younger and elderly patients in this study.
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ABC (angry backfiring C-nociceptor) syndrome-like pain disorder categorized in sympathetic independent pain appeared after amputation during spinal anesthesia. A 69-year-old female who had undergone amputation of the right leg below knee 5 months before, received amputation of the left leg below knee this time because of diabetic neuropathy and gangrene of her both legs. There were no complications in her right leg after the former amputation. ⋯ After changing the body position from left lateral to supine, the left leg was completely anesthetized and the right leg was incompletely anesthetized with only loss of cold sensation. In this state, she had pain in her right leg, and this pain was relieved by intravenous lidocaine administration. It was indicated that this type of pain was caused by the presence of ABC syndrome probably after right leg amputation.
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Case Reports
[Successful management of a patient who developed intra-operative pulmonary tumor embolism].
A 68-year-old female with retroperitoneal tumor extending into the inferior vena cava (IVC) developed massive pulmonary tumor embolism during removal of the tumor. Because of her unstable hemodynamics, emergency pulmonary embolectomy under cardiopulmonary bypass was performed. Successful management of her intra- and post-operative persistent right heart failure led to a satisfactory postoperative course without serious neurological complications. In peri-operative management of a patient with an extended tumor into IVC, prevention of the embolism, detection of the pulmonary embolism and treatment of intra- and post-operative right heart failure are important.