Masui. The Japanese journal of anesthesiology
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Case Reports
[Anesthetic management for elective cesarean section due to placenta previa in a patient with moyamoya disease].
We report the anesthetic management of a 31-year-old female patient with moyamoya disease using general anesthesia combined with epidural anesthesia for a cesarean section due to placenta previa. Epidural anesthesia with 10 ml of 2% lidocaine was first used. Then general anesthesia was induced with thiamylal 200 mg and succinylcholine 60 mg just before starting operation and was maintained with 60% nitrous oxide in oxygen. ⋯ Intracranial blood velocity and regional oxygen saturation were also measured to monitor cerebral blood flow. There was no postoperative pain, and no postoperative neurological defects. On the basis of these findings, it was concluded that general anesthesia combined with epidural anesthesia for elective cesarean section due to placenta previa is effective for perioperative management of a patient with moyamoya disease.
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Neurological complications related to spinal anesthesia are exceptional, but their consequences are serious. We report a case of conversion disorder, which was initially diagnosed as monoplegia caused by spinal anesthesia. The patient was a 36-year-old, 88 kg woman with a history of psychogenic aphonia. ⋯ The reflexes and muscle's tonus were normal and EMG gave normal findings. The result of neurological diagnosis, confirmed the diagnosis of conversion disorder causing her monoplegia because she was under psychic stressful circumstances from her family. Conversion disorder as a cause of monoplegia after surgery under spinal anesthesia should be kept in mind.