Masui. The Japanese journal of anesthesiology
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Stiff-person syndrome is an uncommon disease characterized by muscular rigidity and painful spasms in the axial and limb muscles. We report a 58-year-old woman with stiff-person syndrome undergoing thymectomy under general anesthesia. Before surgery, her medications were 25 mg of diazepam, 2 mg of clonazepam, and 15 mg of gabapentin per day. ⋯ After surgery, she was fully awake and TOFR recovered to 100%, but tidal volume was too low to remove the tracheal tube, and mechanical ventilation was continued in ICU. On the next day, the tracheal tube was removed, and she was discharged from ICU. Because anesthetics may delay the recovery of respiratory function in a patient with stiff-person syndrome, careful assessment of respiratory function is needed at the emergence from general anesthesia.
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Multicenter Study
[Effect of landiolol hydrochloride for intraoperative tachycardia--multicenter questionnaire study].
The purpose of this study was to evaluate effects of landiolol hydrochloride, which is an ultra-short-acting beta-1 selective blocker, for intraoperative tachycardia and to establish practical methods of administration of the drug. ⋯ Information obtained by the questionnaire suggests that bolus injection and/or low-dose continuous administration of landiolol, which are not described in the drug information documents, are effective and safe for treatment of tachycardia during anesthesia.
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Case Reports
[Case of difficult ventilation due to trachea stricture during general anesthesia in a morbidly obese patient].
Obesity has various coexisting illnesses, and the risk of the anesthesia management in an obese patient is high. We report a case of difficult ventilation by trachea stricture during general anesthesia in a morbidly obese patient.
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In surgical graft replacement of the descending aorta graft, one-lung ventilation (OLV) is required to provide adequate surgical view and to allow removal of blood from the left lung. It is best to use a double-lumen tube (DLT) to assure OLV but it is sometimes difficult to place the left-sided DLT due to thoracic aneurysm or the dissection lumen. We retrospectively investigated tracheobronchial anatomy by chest X-ray and chest computed tomography (CT) in 29 cases of descending aorta replacement to determine how best to manage difficult placement of the left-sided DLT. ⋯ We experienced difficulty in placement of the left-sided DLT in 3 of 29 cases of descending aorta replacement. We can predict difficulty of left-sided DLT placement by the presence of compression of the tracheobronchial tree on chest CT.
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Case Reports
[Case of laryngopharyngeal edema after a spinal tumor resection in prone position with extensive neck flexion].
A 63-year-old woman developed laryngopharyngeal edema after a cervical spinal tumor resection in prone position. The tracheal tube was removed after 11 hours of general anesthesia and nasal airway was inserted because stridor was audible. Blisters were found on the skin of the anterior neck of the patient. ⋯ It was considered that the disturbance of venous and/or lymphatic flow of anterior neck due to extensive neck anteflexion during the surgery in prone position had induced the laryngopharyngeal edema; however, we could not verify the cause of the edema. The edema persisted for weeks. We conclude that we should avoid extensive neck anteflexion during surgery in prone position and it is recommended to observe the upper airway for a few hours after extubation because there could be airway obstruction due to delayed and/ or progressive laryngopharyngeal edema.