Masui. The Japanese journal of anesthesiology
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Case Reports
[Insufficient sugammadex effect in an obese pregnant woman undergoing cesarean section under general anesthesia].
A 32-year-old pregnant woman (height 162 cm, weight 86 kg, age of fetus 25 weeks) without preoperative complications underwent an emergent cesarean section under general anesthesia. She was intubated with a 7.0-mm tracheal tube 40 s after receiving rocuronium 0.93 mg x kg(-1) and thiamilal 375 mg. Anesthesia was maintained with oxygen, air, sevoflurane 1.0-2.5%, and fentanyl 425 microg. ⋯ Fifteen minutes after sugammadex administration (train-of-four ratio 14%), she received atropine 0.5 mg and neostigmine 1.0 mg. Ten minutes later, the train-of-four ratio increased to 89%, and the patient was successfully extubated with no respiratory suppression. We speculate that the rocuronium dose (0.93 mg x kg(-1)) was too high in this obese patient, and sugammadex dose at the end of the surgery was not enough for reversal of rocuronium-induced neuromuscular blockade.
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We hypothesized that pre-operative BNP levels predict postoperative morbidity and mortality in patients undergoing non-emergent cardiac surgery. ⋯ Preoperative BNP predicted postoperative morbidity and mortality.
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A 78-year-old woman with low pulmonary function (forced expiratory volume in 1 second of 450 ml) underwent an open incisional pulmonary tissue biopsy for suspected diffuse panbronchiolitis and anti-neutrophil cytoplasmic antibody-associated vasculitis. She was intubated with a double-lumen tracheal tube after receiving 0.57 mg x kg(-1) of rocuronium and 0.9 mg kg(-1) of propofol. Under one-lung ventilation, the PaCO2 was 54-74 mmHg and PaO2 was 121-127 mmHg until 50 min after lung recruitment, after which the PaCO2 decreased to 62-66 mmHg and PaO2 increased to 283-382 mmHg. ⋯ Although the rocuronium-induced neuromuscular blockade was reversed by 2.0 mg x kg(-1) of sugammadex (train-of-four ratio, nearly 100%), it seemed a little difficult to extubate the patient just after the operation because blood gas analysis showed a pH 7.39, PaCO2 of 66 mmHg and PaO2 382 mmHg with FIO2 1.0. The blood gas analysis revealed pH 7.52, PaCO2 44.5 mmH and PaO2 144 mmHg with FIO2 of 0.4. The patient was successfully extubated with no respiratory complication 10 h after the end of the operation on the first postoperative day.
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A 12-year-old male patient with Coffin-Lowry syndrome was scheduled for posterior cervical decompression and fusion for cervical spinal injuries. The patient had features of Coffin-Lowry syndrome including mental retardation, prominent forehead, a short nose with a wide tip, a wide mouth with full lips, short stature, microcephaly, and kyphoscoliosis. We anticipated major troubles related to anesthesia such as difficult ventilation and intubation, communication difficulty during induction and extubation, and difficulty in using a naso-pharyngeal airway. ⋯ When the surgery was completed, we extubated using a tube introducer in the trachea. As we found that the patient's airway was open, we removed the introducer. In conclusion, with a thorough planning of the anesthetic management, we successfully managed anesthesia for cervical spinal surgery in a patient with Coffin-Lowry syndrome.