Masui. The Japanese journal of anesthesiology
-
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.
-
Case Reports
[The use of dexmedetomidine and Airwayscope in airway management of a child with Cornelia de Lange syndrome].
We report anesthetic management of a 22-month-old child with Cornelia de Lange syndrome scheduled for palatoplasty because of cleft palate. Micrognathia and short neck of the patient suggested difficult airway management. For anesthetic induction, 1 microg x kg(-1) dexmedetomidine was loaded intravenously, followed by infusion at a rate of 0.7 microg x kg(-1) x hr(-1) with incremental inhalation of sevoflurane. ⋯ During the Airwayscope operation, pharyngeal reflex, laryngeal reflex and saliva increase were inhibited resulting in good view of the larynx and the lowest Spo2 was 94% temporarily. After intubation, anesthesia was maintained with sevoflurane, remifentanil and fentanyl. Dexmedetomidine infusion was also useful to maintain adequate spontaneous breathing and to achieve awaking before extubation.
-
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.
-
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.
-
This article introduces the equipment used for epiduroscopy and describes its indications, procedures for use, treatment outcomes, the potential complications and future developments. Epiduroscopy is used in the treatment and diagnosis of intractable low back and leg pain in patients in whom nerve block is not efficacious and when pain recurs after operation. The characteristics of epiduroscopy are that it is: 1) safe and less invasive; 2) used for endoscopic washing of the epidural space and fluoroscopic X-ray; 3) it allows injection of an agent into the lesion; and 4) it results in no change in the normal lumbar structure after operation. Epiduroscopy is expected to provide successful outcomes for many patients with intractable low back and leg pain through further improvements in equipment related to epiduroscopy, advances in technology, the accumulation of data regarding its efficacy and safety, and the coverage of treatment by insurance.