Masui. The Japanese journal of anesthesiology
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A 35-year-old pregnant woman (weight, 129.5 kg; height, 156 cm; 37 weeks of pregnancy) with a body mass index of 53 was scheduled for a cesarean section. It was thought that epidural or spinal anesthesia might result in complications due to her severe obesity. It was therefore decided to use general anesthesia following awake intubation. ⋯ During surgery, she developed hypoxia due to upper shift of the diaphragm. After surgery, she was extubated after improvement of her oxygenation under spontaneous breathing. This case demonstrates that difficulties may be encountered during anesthetic management of a severely obese patient undergoing cesarean section.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Postoperative analgesia using continuous lumbar epidural infusion of ropivacaine in comparison with bupivacaine].
Epidural bupivacaine infusion is a commonly used technique for postoperative analgesia because of its motor-sparing properties. Recently a new long acting local anesthetic, ropivacaine, has become available. The aim of this study was to investigate the efficacy of ropivacaine and bupivacaine with regard to postoperative analgesia when administered continuously into the lumbar epidural space. ⋯ After leg orthopedic surgery, 6 ml.hr-1 of 0.2 R or 0.125 B provided enough postoperative analgesia when the spread of anesthesia covered the operated area. 0.2 R would be better compared to 0.125 B in continuous epidural infusion for postoperative analgesia due to less systemic toxicity, even though it accompanies a little more intense motor block.
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A 5-year-old boy with Williams syndrome received open reduction of fracture of the antebrachium twice. He had been diagnosed as having Williams syndrome with some characteristic symptoms, including elfin face, mental retardation and primary pulmonary hypertension. Williams syndrome has a tetrad of cardiovascular disease, elfin face, mental retardation and hypercalcemia. ⋯ Anesthesia was induced with propofol, fentanyl, and vecuronium, and maintained with propofol, fentanyl and the inhalation of oxygen with nitrous oxide. Both anesthetic courses were uneventful and he was discharged without any complications. Special anesthetic considerations should be taken for difficulties of intubation, management of circulatory system, malignant hyperthermia, and hypercalcemia in this syndrome.
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We experienced a case of cesarean section in a patient with a fetus having a prenatally diagnosed huge cervical mass, which could cause airway obstruction immediately after delivery. The fetal cervical mass was confirmed at 19 gestational weeks, and amniocentesis was performed at 33 weeks. At 35 weeks, MRI showed the large mass that could disturb the airway patency after birth, and elective cesarean section was scheduled at 37 weeks. ⋯ After confirming the neonatal oxygenation under manual ventilation, the baby was delivered. After delivery, the mass was diagnosed as cystic hygroma and he was maintained under mechanical ventilation in NICU. Five months later subtotal excision of the cervical cystic hygroma and tracheostomy were performed.
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We managed two patients with secondary hyperthyroidism due to TSH secretion from pituitary adenomas using total intravenous anesthesia with propofol and fentanyl. Both propofol and fentanyl were infused with target-controlled infusion (TCI) systems. The anesthesiologists controlled the target concentration of propofol to maintain the bispectral index (BIS) in a range from 40 to 60, and the target concentration of fentanyl was kept within a range of 2.0 to 3.0 ng.ml-1. ⋯ The necessary concentration of propofol during anesthesia was 2.5 to 4.0 micrograms.ml-1, and the emergence concentration of propofol was 1.4 to 1.7 micrograms.ml-1. These values were almost equal to those obtained in patients without thyroid disease. In conclusion, we could maintain the anesthesia for the patients with hyperthyroidism safely and stably by titrating the concentration of propofol and fentanyl based on the BIS value, and by administrating propranolol and PGE1 to avoid hypertension and tachycardia.