Masui. The Japanese journal of anesthesiology
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A radical hysterectomy was performed in a patient complicated with bronchiectasis, under combined spinal-epidural anesthesia. The patient was asymptomatic and preoperatively diagnosed with bronchiectasis on an anesthetic consultation with an anesthesiologist. ⋯ It was necessary to administer a supplemental epidural dose of 0.375% ropivacaine fifty minutes after the start of the operation. Postoperative epidural analgesia was effective and no perioperative complications were observed.
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Case Reports
[A case of successful tracheal tube exchange with Airway Scope for tube damage during maxillo-mandibular osteotomy].
We report a case of surgical vertical-section of the nasoendotracheal tube during operation, resulting in intra-operative ventilatory difficulties. The patient was a 32-year-old female, scheduled for Maxillo-Mandibular osteotomy under general anesthesia. She was intubated with I. ⋯ Therefore, we performed tube exchange smoothly and safely. The extubated tracheal tube had serious cut on cuff inflation line made by surgical maneuver. In the case of suspected laryngeal edema or tracheal tube injury, use of Airway Scope for tube exchange may be a safe and reliable method.
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We describe three consecutive cases of successful anesthetic management for pheochromocytoma resection under balanced anesthesia with sevoflurane inhalation and extremely high-dose remifentanil infusion. This case series aimed to examine whether the aggressive dosing of remifentanil, exerting both depressor and bradycardic actions with short durations, is applicable for hemodynamic control during pheochromocytoma resection. The remifentanil infusion rate was set to maintain the systolic arterial pressure below 150 mmHg and heart rate below 100 beats x min(-1). ⋯ Ephedrine 12 mg was employed following tumor removal. This anesthetic regimen thus allowed minimal or no concomitant use of depressors during tumor manipulation and vasopressors following tumor removal. In conclusion, the liberal use of remifentanil for the anesthetic management of pheochromocytoma resection appears to be simple, safe and effective.
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A 25-year-old parturient with Marfan's syndrome was scheduled for cesarean delivery. She suffered with severe scoliosis and asymptomatic aortic root dilatation. To establish a cardiovascular stability and prevent aortic dissection perioperatively, we selected the use of remifentanil, an ultra-short acting opioid analgesic with general anesthesia. ⋯ A lively infant was delivered and Apgar scores were 8 and 9 at 1 and 5 min, respectively. Their post-delivery courses were uneventful. Remifentanil was useful for anesthetic management in a pregnant patient with Marfan's syndrome undergoing cesarean delivery, although attention to infant's respiratory condition should be paid because remifentanil can cross the placenta.
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Case Reports
[Anesthetic management of a low birth weight infant with giant sacrococcygeal teratoma].
We report the anesthetic management of a low birth weight infant (1912 g including the tumor) with a giant sacrococcygeal teratoma (Altman type II). The diagnosis was prenatally made at 24 weeks of gestation. She was delivered by emergent cesarean section at 28 weeks gestation, because fetal heart failure was aggravated by arteriovenous shunting through the tumor. ⋯ The resected tumor weighed 766 g, total blood loss was 770 ml and blood transfusion was 965 ml. Although transient acidosis and hyperkalemia occurred, the surgery was completed and she was transferred to a neonatal intensive care unit in stable condition. In this case, nasotracheal intubation and the insertion of a central venous line were necessary and useful for the anesthetic management of the resection of giant sacrococcygeal teratoma.