Masui. The Japanese journal of anesthesiology
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We describe the risk management of pediatric anesthesia. The most important risk management of pediatric anesthesia is airway and temperature management. ⋯ The management of patients' temperature, including control of room temperature should be taken into consideration. In addition, careful attention should be paid not to introduce air bubbles in any lines, especially in patients with congenital heart diseases.
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Control of the airway is fundamental for the safe anesthetic practice of head and neck surgery and careful assessment of airway must be undertaken preoperatively. Safe tracheal intubation method should be decided after the airway assessment. ⋯ Emergency anesthesia for neck and head surgery is most difficult. Experienced personnel and several kinds of devices for securing the airway should be gathered in the operating room before induction of anesthesia.
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Case Reports
[Anesthetic management of a patient with mitochondrial encephalomyopathy for renal transplantation].
A 52-year-old man with mitochondorial encephalomyopathy was scheduled for renal transplantation from a living donor. He had some characteristic features including muscle weakness, deafness, cerebellar ataxia, diabetes meritus and renal failure. Anesthesia was induced with bolus infusion of propofol 1 mg x kg(-1) and continuous infusion of remifentanil at 0.15 microg x kg(-1) x min(-1) was started. ⋯ After administration of naloxone 40 microg to antagonize the action of remifentanil, the patient recovered fully from the respiratory depression. The urine output was depressed initially after implantation of donor's kidney, but gradually increased to a usual recovery pattern. This case suggests that careful administration of remifentanil is mandatory in a patient with mitochondorial encephalomyopathy which enhances respiratory depression from opioids.
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Arrhythmia during general anesthesia occurrs occasionally as a result of the effect of inhalation anesthetic agent on cardiac conduction. We experienced a case of atrioventricular junctional rhythm (AVJR) during maintenance of general anesthesia with sevoflurane. A 61-year-old woman with normal preoperative electrocardiogram was scheduled for right total knee arthroplasty and autologous iliac crest bone graft under general and epidural anesthesia. ⋯ After discontinuation of sevoflurane at the end of the operation, isorhythmic dissociation returned to sinus rhythm. Sevoflurane could induce atrioventricular conduction disturbance leading to isorhythmic dissociation of AVJR. We should be aware that hypotension can result from isorhythmic dissociation during sevoflurane anesthesia.
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Case Reports
[Total intravenous anesthesia with propofol and remifentanil for a patient with myotonic dystrophy].
A 54-year-old woman, complicated with myotonic dystrophy, underwent laparoscopic cholecystectomy for cholelithiasis. The patient was given total intravenous anesthesia using propofol, remifentanil and vecuronium, combined with epidural anesthesia using ropivacaine. ⋯ The postoperative course was uneventful. The anesthesia with remifentanil is extremely useful for patients with myotonic dystrophy.