Masui. The Japanese journal of anesthesiology
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Case Reports
[A case of delayed arousal after anesthesia due to aberrant epidural catheter placement in a blood vessel].
A 71-year-old man underwent a total gastrectomy. An epidural catheter was inserted before the induction of general anesthesia. Blood was withdrawn from an epidural catheter inserted at T8-9 interspace with a median approach. ⋯ When we carefully aspirated the epidural catheter, fresh blood was withdrawn from the catheter. We confirmed that the delayed arousal was due to the administration of ropivacaine into the blood by aberrant epidural catheter placement in a blood vessel. Unaccountable tachycardia and mild hypertension observed persistently during the operation would have been the warning to the toxicity of local anesthetics during general anesthesia.
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In order to secure airway during awake craniotomy, we used i-gel to perform positive-pressure ventilation in 7 patients for their anesthetic management. During removal of a tumor around the motor speech center, anesthetic management including asleep-awake-asleep technique was applied for speech testing. ⋯ Leakage around i-gel, and its differences between inspiration and expiration were negligible, while the tidal volume was adequate. We conclude that i-gel is useful for anesthetic management for awake craniotomy procedure for both securing airway and ventilation.
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Development of instruments for spinal cord stimulation is remarkable. We can implant two cylinder-type stimulation electrodes in parallel into the spinal epidural space. We call this method for dual-lead SCS. ⋯ Dual-lead SCS combined with low-dose ketamine drip infusion method is useful for the treatment of various kinds of neuropathic pain. Even if the direct effect of ketamine is transient, effects that provide release from central sensitization and the wind-up phenomenon may be important to increase the effects of dual-lead SCS. Based on the development of dual-lead SCS, SCS therapy has become an important and powerful method for the treatment of intractable pain.
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Case Reports
[A case of prolongation of rocuronium neuromuscular blockade in a pregnant patient receiving magnesium].
A 35-year-old pregnant female with systemic lupus erythematosus and lupus nephritis underwent emergency cesarean section at 24 weeks of gestation under general anesthesia. The patient had received magnesium sulfate with a diagnosis of pregnancy-induced hypertension since 20 weeks of gestation. Anesthesia was induced with thiopental 3.5 mg x kg(-1) and tracheal intubation was facilitated by administration of rocuronium 1.0 mg x kg(-1). ⋯ After operation, no twitch was noted on the ulnar nerve TOF monitor. The TOF returned to 4/4 at postoperative 11 hours and the patient was extubated uneventfully. When rocuronium is used to facilitate general endotracheal anesthesia in a patient for emergency cesarean delivery, it is important to recognize that magnesium may prolong neuromuscular block significantly.
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Case Reports
[Awake insertion of i-gel under dexmedetomidine sedation in a patient with severe obstructive sleep apnea syndrome].
We report a successful awake insertion of the i-gel supraglottic airway device under dexmedetomidine (DEX) sedation in a patient with severe obstructive sleep apnea syndrome and symptomatic angina. A 71-year-old man was scheduled for open stoma closure under general anesthesia. Given the patient's history of difficult mask ventilation during anesthesia for resection of rectal cancer, we decided to perform awake i-gel insertion under DEX sedation and regional anesthesia with lidocaine. ⋯ We also performed transversus abdominis plane block and rectus sheath block with ropivacaine, as severe respiratory suppression due to continuous intravenous fentanyl infusion had been observed in the previous operation. No vital sign change or respiratory suppression was noted upon recovery from general anesthesia. Awake insertion of a supraglottic airway device, such as i-gel, under DEX sedation can be effective for airway management in patients with severe obstructive sleep apnea syndrome.