Masui. The Japanese journal of anesthesiology
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We evaluated the effectiveness of low-dose patient-controlled epidural analgesia (PCEA) in the patients undergoing laparoscopic gynecological surgery, and investigated the difference of postoperative pain between patients for laparoscopic ovarian cystectomy and those for myomectomy. ⋯ These findings suggest that low dose PCEA is effective for patients who undergo laparoscopic gynecological surgery.
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Case Reports
[2009 Japanese Society of Latex Allergy guidelines for the safe management of latex allergy].
Latex allergy is an IgE-mediated reaction to natural latex antigen. Operating room equipment frequently includes medical devices, such as surgical gloves, intravenous lines, and urinary catheters, which are made from latex or contain latex. These products can trigger an allergic reaction that can result in anaphylactic shock. ⋯ A 49-year-old male doctor with a history of allergy to latex gloves was scheduled for laparoscopic cholecystectomy under general and epidural anesthesia for recurrent, acute cholecystitis. The anesthesia and operation were performed uneventfully with latex-free medical devices and machines in a latex-safe environment in the operating room under the new guidelines. Safe anesthetic management under the 2009 guidelines should be available for all operations in Japan on patients with latex allergy.
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Case Reports
[Case of Rett syndrome monitored with BIS and neuromuscular monitor during total intravenous anesthesia].
We describe a case of 8-year-old female patient with Rett syndrome undergoing bilateral tonsillectomy and adenotomy. She was monitored with BIS and neuromuscular monitor using TOF during total intravenous anesthesia (TIVA) with propofol, remifentanil, ketamine and rocuronium. ⋯ Her recovery from anesthesia and neuromuscular blockade was also smooth associated with satisfactory sedated states. BIS and neuromuscular monitor may be useful in TIVA for a patient with Rett syndrome.
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There are several specific considerations regarding seizure control during the perioperative period in patients who are on a ketogenic diet (KD). A KD is high in fat and low in protein and carbohydrates and has a long history of use for treatment of intractable seizures in children. ⋯ We report a case in which a 3-year-old boy with seizure was on a KD and scheduled for the treatment of left undescended testis under propofol anesthesia and acetate Ringer administration. Induction and maintaining of anesthesia using propofol was safe and reasonable for a patient on a KD.
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A 62-year-old man with hypertension was scheduled for discectomy at L4-5 in prone position. Anesthesia was induced with propofol 70 mg, fentanyl 0.75 mg and rocuronium 40 mg and maintained with sevoflurane 0.8-2.0% in oxygen 2 l x min(-1) and nitrous oxide 2 l x min(-1). ⋯ This case achieved a complete response to quick administration of the coronary vasodilator and antiarrhythmic agent, in this case whose coronary spasm was suspected on the basis of ST elevation in the first place. We have to be careful of various initiating factors for coronary spasm each time during anesthesia as it is difficult to assess its clinical risk, especially in prone position because actual coronary flow is much lower and cardiac resuscitation is difficult in a sudden cardiac complication.