Masui. The Japanese journal of anesthesiology
-
Case Reports
[Transient increase of bispectral index in a patient with bronchoconstriction after endotracheal intubation].
A 62-year-old woman (148 cm, 48.5 kg) with a history of bronchial asthma underwent an emergency appendectomy. Ten days before the operation she developed symptoms of wheezing while under asthma medication. An endotracheal tube (7 mm) was inserted after the induction of general anesthesia with intravenous injection of fentanyl 100 micrograms, propofol 100 mg and vecuronium 10 mg under Sellick's maneuver. ⋯ Upon completion of the operation, the endotracheal tube was removed without any events. The patient gave no sign of awareness during the operation. When severe bronchoconstriction prevents the absorption of anesthetics from the lung alveoli, additional intravenous anesthetics should be administered to maintain stable amnesia.
-
Case Reports
[Anesthetic management of a patient with olivopontocerebellar atrophy using heart rate variability (HRV)].
A 65-year-old woman with olivopontocerebellar atrophy (OPCA), manifested with cerebellar ataxia mainly, with coexisting impairment of the autonomic nervous system function, and extrapyramidal symptoms, was scheduled for cholecystectomy. With no premedication, anesthesia was induced with sevoflurane and maintained with 1-1.5% of sevoflurane and 66% of nitrous oxide mixed with oxygen. Heart rate variability (HRV) calculated from ECG was used for a monitor of the autonomic nervous system activity. ⋯ We considered that the patient might have postganglionic sympathetic nerve hypersensitivity against inotropic agents. When her blood pressure decreased temporarily after the induction of anesthesia, a bolus dose of ephedrine 1 mg wa given intravenously, which stimulated the sympathetic nervous system indirectly, and could increase her blood pressure. Hypotension during anesthesia in a patient with OPCA with severe autonomic nervous failure was successfully treated by a minimal dose of ephedrine.
-
The effect of inhalation induction with sevoflurane on left ventricular(LV) function has not been evaluated in adults. We assessed the effect of inhalation induction with sevoflurane on left ventricular systolic and diastolic function in adult patients using transthoracic echocardiography. ⋯ During inhalation induction with sevoflurane in adult patients, sevoflurane caused negative inotropic effects, but preserved LV diastolic function.
-
We report anesthetic management for a 5-month-old baby with an epiglottic cyst causing stenosis of the upper airway and growth failure. A flexible guide wire was first inserted into the trachea through the forceps port of the fiberoptic bronchoscope (O. D. 3.5 mm) nasally. ⋯ D. 3.5 mm) passed over it. Her symptom improved after removal of the cyst. A flexible guide wire combined with fiberoptic bronchoscope is useful in tracheal intubation for a baby with a difficult airway.