Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study
[Comparison of intraoperative stress hormones release between propofol-remifentanil anesthesia and propofol with epidural anesthesia during gynecological surgery].
Remifentanil recently comes to be used for intraoperative analgesia instead of epidural anesthesia in gynecological surgery. It seems to offer the same stability in vital signs, but stress response during remifentanil anesthesia has not been evaluated. Therefore, we compared remifentanil anesthesia with epidural anesthesia regarding stress hormones. ⋯ The inhibition of stress hormone secretion during operation was less in R than E. Regarding stress response, total intravenous anesthesia with remifentanil seems to be a proper method, but to have less potency than general anesthesia using epidural block.
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As myasthenia gravis affects neuromuscular transmission, these patients show various responses to neuromuscular blocking drugs. We report a successful use of the sugammadex in a myasthenic patient to reverse rocuronium-induced neuromuscular block. ⋯ After spontaneous recovery of T1, we administered sugammadex 200mg intravenously, reversing neuromuscular blockade to a train-of-four ratio (T4/T1) of 100% within 30 sec. Sugammadex can be used to reverse rocuronium-induced neuromuscular blockade in patients with myasthenia gravis, thereby avoiding the need for reversal with acetylcholinesterase inhibitors.
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We report a case of thoracoscopic pulmonary resection for pneumothorax in a patient with Becker muscular dystrophy The sensitivity of nondepolarizing muscle relaxant in a patient with muscle dystrophy is reportedly higher than in a patient without muscle disease, and the duration of the effect is known to be prolonged. In a 26-year-old man (height 160 cm, weight 39 kg) with Becker muscular dystrophy, general anesthesia was induced with target controlled infusion of propofol (3.0 microg x ml(-1)) and 0.4 microg x kg(-1) of min(-1) of remifentanil. A small amount of rocuronium was also administered additionally until TOF ratio reached to 0%. ⋯ The duration of surgery was 68 min. We confirmed 84% recovery of TOF ratio 90 min after injection of rocuronium, and extubated the patient without reversal of rocuronium. We found that the maximum concentration in the plasma or effective site (Cp/Ce) of rocuronium was reached at the time of intubation.
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We experienced a patient with respiratory insufficiency after resection of the aortic aneurysm and replacement with a synthetic conduit which recovered by airway pressure release ventilation (APRV) dramatically. A 44-year-old man diagnosed as aortic aneurysm of the descending thoracic aorta was admitted to our hospital and an operation was scheduled. The operation lasted for 19 hours and the time of general anesthesia was 23 hours. ⋯ Additionally, oxygenation was improved. He was weaned from a ventilator on postoperative day 5. We have demonstrated that APRV is an important tool that should be used to improve severe respiratory insufficiency.
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A 61-year-old woman with pulmonary lymphangioleiomyomatosis was scheduled for video-assisted thoracoscopic surgery for partial resection of the lung. The patient had micrognathism and a recent history of difficult airway management [difficult mask ventilation and intubation (Cormak grade III)]. ⋯ Therefore, a 32 Fr left-sided Blue Line endobroncheal tube was nasotracheally intubated using a fiberscope (3.1-mm diameter). Nasotracheal intubation with a 32F Blue Line endobroncheal tube can be a choice for patients with difficult airway when one lung ventilation is required.