Masui. The Japanese journal of anesthesiology
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Case Reports
[Two cases of intraoperative awareness during intravenous anesthesia with propofol in morbidly obese patients].
We experienced two cases of intraoperative awareness during intravenous anesthesia with propofol and fentanyl in morbidly obese patients. The rates of propofol infusion were calculated according to the adjusted body weights, or reduced intentionally as obese patients are generally believed to require lower doses of propofol compared with non-obese patients. Our postoperative analysis by simulations using the anesthesia records showed that, when the simulation was based on real body weight, the blood/effect-site concentrations of propofol in both patients would have been below the necessary levels to keep the patients unconscious during the operation, but when the simulation was based on adjusted body weight, those concentrations might have been within the necessary range to maintain an adequate hypnotic level. We propose that the rate of propofol infusion should be the same in obese and non-obese patients and should be calculated according to the real body weight not to the adjusted body weight.
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The purpose of this investigation was to determine whether elimination of premedication before general anesthesia affects preoperative anxiety. ⋯ We conclude that elimination of premedication does not increase anxiety in comparison with patients receiving sedatives, but makes patients feel comfortable by way of preoperative conversation. Elimination of premedication also makes ambulatory entrance possible, both improving safety with respect to patient identification and reducing the demand on nursing.
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A 71-year-old man with a history of allergic rhinitis for 6 years received spinal anesthesia using 2 ml of 0.3% dibucaine for transurethral prostatectomy. Two months previously he had undergone prostate biopsy and cystoscopy under spinal anesthesia with isobaric bupivacaine uneventfully. Forty five minutes after injection of dibucaine he complained of itching in the periorbital area, and developed tremor and muscle rigidity followed by loss of consciousness. ⋯ Continuous infusion of epinephrine was needed for complete relief of symptoms. An intradermal test with 0.3% dibucaine carried out 6 days after surgery demonstrated a 12 x 8 mm wheal with flare. Although anaphylactic reaction to an amide local anesthetic has been reported to be quite rare, this is the 7th case report of anaphylactic reaction to dibucaine used for spinal anesthesia in Japan.
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Young-Simpson syndrome (YSS) is a rare malformation syndrome characterized peculiar facies, congenital hypothyroidism, congenital heart disease, and postnatal growth deficiency. A 3-year-old boy with YSS underwent tracheostomy for respiratory failure under general anesthesia using sevoflurane, nitrous oxide and oxygen. Although he was assumed to be difficult for intubation due to micrognathia and macroglossia, tracheal intubation was done without difficulty. No complications were observed during the 40 minutes of the operation.
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We experienced four cases of craniotomy in which motor evoked potential (MEP) and somatosensory evoked potential (SEP) were monitored alternately. Anesthesia was induced with propofol and fentanyl, and it was maintained with continuous infusion of propofol. ⋯ We could obtain the largest amplitude of MEP using five consecutive stimuli of which duration and frequency were 0.5 milliseconds and 500 Hz, respectively. Anesthetic management using propofol and fentanyl is useful for craniotomy with monitoring of MEP and SEP.