Masui. The Japanese journal of anesthesiology
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We report a case of a 35-year-old woman with myotonic dystrophy and severe obesity of BMI 43.3 who showed persistent apnea at emergence after ovarian resection. The patient received an iv induction with minimum dose of propofol and vecuronium 3 mg. Anesthesia was maintained with propofol, 50% nitrous oxide and 50% oxygen mixture and epidural anesthesia. ⋯ Spontaneous breathing at the rate of 17 x min(-1) started soon after extubation. We assume that this apnea was caused by breath holding. Whether this breath holding is specific to myotonic dystrophy or not, anesthesia for patients with this disease requires careful attention for perioperative respiratory management.
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Case Reports
[General anesthesia outside the operating room in patients with Pierre-Robin syndrome].
Anesthesiologists are increasingly asked to involve in administering general anesthesia outside the operating room for such procedures as computed tomography, magnetic resonance imaging or angiography. Especially, pediatric patients require some kind of sedation or general anesthesia during these procedures. We report general anesthesia outside the operating room in patients with Pierre-Robin syndrome, who are expected to have possible difficult airway. ⋯ Fortunately, tracheas were successfully intubated without using special devices, although cautious care during induction was taken. According to development of medical and surgical procedures, it is readily presumed that anesthesiologists will be more often involved in the sedation or anesthesia conducted outside the operating room in future. Anesthesiologists should always ensure enough staffing, proper monitoring and equipment when sedation or anesthesia is conducted outside the operating room, particularly if patients have anesthetic risks.
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Comparative Study
[Early postoperative complications in patients with Moyamoya disease--a comparison of inhaled anesthesia with total intravenous anesthesia (TIVA)].
Moyamoya disease is a rare neurovascular disorder that requires special anesthetic managements during revascularization procedures. We have investigated the incidence of early postoperative complications under inhaled anesthesia in comparison with total intravenous anesthesia (TIVA) retrospectively. ⋯ Several previous studies reported the excellence of TIVA for revascularization procedure on the basis of regional blood flow because inhaled anesthesia may provoke intracerebral steal in moyamoya disease. Our investigation in this study revealed that both anesthetic methods have no significant difference in postoperative complications during the first 2 weeks after operation. Thus further study should be needed to verify the safety of inhalation anesthetics in patients with moyamoya disease.
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Transient right bundle branch block occasionally occurs under anesthesia. We report a case of heart rate dependent right bundle branch block during sevoflurane anesthesia. A 74-year-old man was scheduled for partial hepatectomy. ⋯ There was no change in his vital signs and subjective symptoms. Serum level of creatine phosphokinase (CPK) isoenzyme was within normal ranges, and change of ventricular conduction corresponded with the change of heart rate. These observations suggest that transient CRBBB in this case was rate dependent.
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There is little information on gender related problems in medicine from a point of view of the male anesthesiologists. ⋯ More than half of male anesthesiologists felt a gender inequity especially in family responsibility. In addition, it is impressive that most of male anesthesiologists were unaware of gender inequity in promotion in face of the fact that the number of the female professors was very small. Systemic effort is required to grapple with gender inequity problems to change the social organization in the field of medicine.