Masui. The Japanese journal of anesthesiology
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We experienced a 55-year-old female patient who was diagnosed as femoral neuropathy after radical ovariectomy. An epidural catheter was introduced at T11-12 interspace without any problems and general anesthesia was induced and maintained. The operation ended uneventfully. ⋯ Those findings led us to diagnose with femoral neuropathy probably due to abdominal retractors or the operation itself, and insertion of epidural anesthesia could not be the cause of neuropathy. Her symptom was ameliorated with a conservative therapy after four months. We should perform fine neurological examinations when neurological complications occur, especially when we use epidural catheters, and also should have the knowledge about those complications.
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We experienced a case of dilution coagulopathy successfully treated with cryoprecipitate. A seven-month-old male infant with tetralogy of Fallot and right femoral arteriovenous fistula had undergone a modified Blalock-Taussig shunt at 63 days of age. He was scheduled to undergo complete repair of TOF and closure of femoral arteriovenous fistula. ⋯ In the present case, dilution coagulopathy occurred as a result of the combination of excessive fluid infusion due to massive bleeding and blood dilution due to CPB. Fresh frozen plasma could have been contraindicated to supplement fibrinogen because the patient's body weight was low. Cryoprecipitate, a highly concentrated source of fibrinogen, was effective for correcting fibrinogen deficit.
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Hypotension is a common adverse effect of spinal anesthesia (SA). Preoperative fluid infusion is recommended to prevent hypotension during caesarean section. The aim of this study is to document relationship between preoperative total body water (TBW) and the amount of the vasopressors given intraoperatively and to evaluate the change of maternal body water composition (BWC). ⋯ Preoperative TBW does not affect the amount of vasopressors given during caesarean section, which suggested massive fluid infusion can not always prevent hypotension after SA. A slight changes in TBW and ECW may be induced by SA, while the exact physiological and clinical significance of these observation remains to be elucidated.
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Recently, in addition to bronchofiberscope, the new equipments to manage difficult intubation are available. However, it is unknown whether the incidence of difficult intubation decreases or not. In order to determine the incidence of severe difficult intubation, we conducted a survey of patients who presented with severely difficult intubation during 2005-2010. ⋯ The incidence of severely difficult intubation was 0.3% in Hokkaido university hospital during 2005-2010.
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Ketamine is associated with an increase in the bispectral index (BIS) values that can lead to an overdose of hypnotic agents. We investigated the effect of ketamine on BIS values during general anesthesia with a target-controlled infusion (TCI) of propofol and infusion of remifentanil. ⋯ Under stable propofol and remifentanil anesthesia, a small dose of ketamine did not increase the BIS value over the next 15 min.