Masui. The Japanese journal of anesthesiology
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A 56-year-old man with 3 coronary vessel disease (#5, HL, #13), underwent OPCABG. Anesthesia was induced with propofol (PRO), fentanyl and vecuronium, and maintained with continuous infusion of remifentanil (REM), PRO and vecuronium. After the revascularization of 3 vessels, we changed the infusion anesthetics from REM to dexmedetomidine (DEX), and 40 minutes later we extubated immediately after the operation in the operating room with no problems. ⋯ But this method, general anesthesia by combination of propofol-remifentanil-dexmedetomidine without epidural analgesia, was very stable in the operative period, and respiration was well maintained after extubation in the operating room. There were no critical hypercapnea, hypoxia, ventilatory problems and any cardiac complications. This method provided suitable conditions for maintenance and emergence of anesthesia, and enabled a shorter stay in ICU of below 24 hours.
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Case Reports
[Intrathecal segmental analgesia with a single dose of bupivacaine for cancer pain in the abdominal wall].
A 48-year-old woman, diagnosed as colon cancer with metastases in the liver, lung, bone and left rectus abdominis, developed refractory left abdominal pain in spite of escalating administration of opioids and nerve block therapy, and intrathecal analgesia was applied. The tip of the catheter was intrathecally placed at the level of the T8 vertebra and pain relief was obtained with a daily dose of bupivacaine 36 mg producing segmental analgesia of the area between the 7th and 10th thoracic segments and preserving sensory and motor functions of the lower limbs. ⋯ Side effects related to systemic opioids, such as nausea, vomiting and sleepiness, significantly improved and she was able to walk to the toilet. It is suggested that when the site of pain is limited to the truncus, intrathecal analgesia only with local anesthetics can be applied without affecting functions of the lower limbs.
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Case Reports
[Case of laparoscopic cholecystectomy in a patient with glucose-6-dehydrogenase deficiency].
We report management of anesthesia in a patient suffering from glucose-6-phosphate dehydrogenase (G6PD) deficiency, a condition that induces acute hemolysis when associated with surgical stress and infection, or following the application of oxidant drugs. A 5 year-old-male patient, suffering from G6PD deficiency was scheduled for laparoscopic cholecystectomy. The patient had exhibited signs of hemolysis during the course of various infections and after ingesting fava beans (favism). ⋯ There was no hemolytic change during the perioperative period. It was clear that this combination of drugs provided safe anesthesia for the G6PD patient in the present study. The most important considerations for patients with G6PD deficiency is firstly, the avoidance of oxidative stress, which can be caused by a variety of different conditions, and secondly, the use of anti-oxidative anesthetic drugs.
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Case Reports
[Combined spinal-epidural anesthesia for cesarean section in a patient with dilated cardiomyopathy].
We report successful anesthetic management of elective cesarean section in a 31-year-old patient with dilated cardiomyopathy (DCM) using combined spinal-epidural anesthesia (CSEA). After inserting an arterial catheter and central venous catheter, isobaric bupivacaine (0.5% ; 5 mg) with fentanyl 10 microg was injected intrathecally at the L4-5 interspace under administration of dopamine 3 microg kg(-1) min(-1). 10 min and later, a total of ropivacaine (0.5%; 70 mg) with fentanyl 50 microg was titrated at 2-3 min intervals through the epidural catheter inserted at the L1-2 interspace resulting in analgesic level of T4 25 min after induction of spinal anesthesia. A baby was delivered uneventfully with good Apgar score, and the patient's perioperative hemodynamic change was minimal. CSEA is a reliable, titratable technique, which provides excellent analgesia with minimal hemodynamic changes for patients with DCM undergoing cesarean section.