Masui. The Japanese journal of anesthesiology
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Case Reports
[Electromyographic activity increases the bispectral index up to 98 during anesthesia].
We report the patients who developed sudden unpredicted increases of bispectral index (BIS) value during sevoflurane and fentanyl anesthesia. After the epidural catheter placement, anesthesia was induced with propofol and fentanyl, and muscular relaxation was obtained by vecuronium for tracheal intubation. Anesthesia was maintained with 1-1.5% sevoflurane, intermittent administration of fentanyl and epidural infusion of ropivacaine. ⋯ At first, the BIS was decreased with small dose of supplemental anesthetics, but finally, it was up to 98 and the depth of anesthesia could not be assessed by BIS value. Because slight shivering was found in the patient immediately after emergence, electromyographic activity might have falsely elevated the BIS excessively. No clear recall or explicit memory during operation was observed after anesthesia, but anesthesiologists might better pay much more attentions to unpredictable changes of anesthetic depth during anesthesia.
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We report resistance to vecuronium bromide (Vb) induced muscle relaxation for general anesthesia in a patient with chronic renal failure (CRF) and secondary hyperparathyroidism (HPT). An 81-year-old man (body weight : 52 kg) diagnosed with bladder carcinoma was scheduled for a total cystectomy. In the operating room, standard monitors were applied except for a nerve stimulator. ⋯ The surgery was concluded uneventfully. Although the total amount of Vb administration was 14 mg in 3 hr anesthesia time, he was awake rapidly and extubated sooner than expected. We suspect that resistance to Vb has been caused in part by secondary HPT and it appears necessary to take care when administering Vb in CRF patients with secondary HPT, especially at the induction of general anesthesia.
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The anesthesiologists began offering epidural analgesia for labor pain at the Hamamatsu University Hospital in cooperation with the obstetricians and the midwives in August, 2005. It is necessary for anesthesiologists to concentrate on caring of the parturients in order to offer safe and effective labor epidural analgesia. We discussed how to begin and continue to offer the labor epidural based on our experience while the number of anesthesiologists is insufficient.
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Obstetric anesthesia has made significant progress over the last 50 years. It is one of the major subspecialties in anesthesia in US. Society for Obstetric Anesthesia and Perinatology (SOAP) was founded in 1968. ⋯ It is encouraging, however, that the number of attendants in obstetric anesthesia sessions in JSA seems increasing. SOAP has played an important role in the education and progress of obstetric anesthesia in US. I hope that the joint symposium of SOAP, Bunben to Masui Kenkyukai, and JSA at 39th SOAP annual meeting will facilitate the progress of obstetric anesthesia in Japan.
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The following featured articles are the proceedings of the panel discussion at the 19th Japanese Society of Regional Anesthesia, which was held on September 2nd, 2006 in Osaka. The president of the meeting, Professor Akira ASADA at Osaka City University Graduate School of Medicine, chose this topic among various aspects of regional anesthesia practice. Obstetric anesthesia practice relies heavily on regional anesthesia for both cesarean section and labor analgesia. ⋯ Some of them have started the labor epidural analgesia service by tackling obstacles. The others have strong interests in obstetric anesthesia, but yet are unable to provide labor analgesia. By sharing their success and difficulties, the readers of this discussion would be able to obtain some insights when they set up labor epidural analgesia service at their own practice settings.