Masui. The Japanese journal of anesthesiology
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Case Reports
[Case of anesthesia for laparoscopic cholecystectomy in a patient with a history of frequent anaphylaxis].
Idiopathic anaphylaxis is a rare disease that induces anaphylactic shock without extrinsic incentive. We had a patient with such frequent episodes undergoing laparoscopic cholecystectomy. ⋯ Consequently, we can safety manage anesthesia without episode of anaphylactic shock. To prepare for anaphylaxis we prepared usual therapeutic drugs for shock and measured serum tryptase, which has longer half-life than that of histamine.
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A 59-year-old man with chronic renal failure underwent the ascending colectomy. After administration of neostigmine 2 mg, his postoperative neuromuscular recovery was good. ⋯ But we failed to reverse neuromuscular blockade and the patient fell into respiratory depression. After a chain of two operations, the administration of neostigmine in second operation requires circumspection when the effect of neostigmine administrated in the first operation is continuing, because the proper evaluation of residual neuromuscular blockade is difficult.
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We report a second case of awareness during general anesthesia with sevoflurane supplemented with fentanyl. A 58-year-old man, weighing 61 kg, underwent an 8.8-hour operation for a malignant tumor of the right mandible. ⋯ The patient became agitated in the recovery room and could recall his visual memory during the operation. We speculated contribution of visual input through the open eye and/or the effects of cranial bone oscillation during the surgery to his intraoperative awareness.
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Recently, various less-invasive cardiac output monitors are used for a variety of cases. We used FloTrac system for a patient with severe dilated cardiomyopathy (LVDd/Ds = 75/62 mm, EF = 22%) and recognized its limitation. A 52-year-old woman underwent left partial mastectomy. ⋯ Its accuracy is worse with arterial wave artifact, compromise of the arterial catheter, aortic regurgitation, intense peripheral vasoconstriction, irregular pulse and severe cardiac hypofunction. Thus, its reliability is influenced by various conditions, especially in critically ill patients. FloTrac system is very useful for the management of cardiocirculatory dynamics, but we should be familiar with its limitations.
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Retroperitoneal laparoscopic surgery has recently become a common procedure for urological fields. We investigated the incidence of respiratory complications and their background during retroperitoneal laparoscopic surgical procedures performed in the kidney position. ⋯ Respiratory complications, such as atelectasis or pneumomediastinum, occurred in more than half of the patients after urological retroperitoneal laparoscopic surgical procedures in the kidney position. Careful perioperative management and postoperative CXR examinations are essential for early detection of such potentially life-threatening complications.