Masui. The Japanese journal of anesthesiology
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Minimally invasive esophagectomy has become popular as a surgical procedure for esophageal cancer. We describe bilateral continuous thoracic paravertebral blocks for perioperative pain management in 3 patients who underwent minimally invasive esophagectomy. After anesthesia induction, bilateral thoracic paravertebral catheters were placed under ultrasound guidance with the patients in left lateral decubitus position at the sixth or seventh right intercostal space and eighth or ninth left intercostal space, respectively. ⋯ Numerical rating scales of postoperative pain at rest and when coughing were 4 or less for 48 hr after surgery. No complications related to thoracic paravertebral catheterization were observed. Bilateral continuous thoracic paravertebral blocks at different intercostal levels can provide good perioperative analgesia for minimally invasive esophagectomy.
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Epidural analgesia or paravertebral block is widely used in postoperative analgesia for video-assisted thoracic surgery (VATS). We investigated the efficacy of the continuous intravenous infuion of fentanyl combined with intercostal nerve block, in comparison with the continuous epidural analgesia. ⋯ Continuous intravenous infusion of fentanyl combined with intercostal nerve block is effective in the postoperative analgesia for VATS, as well as continuous epidural analgesia.
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The stiff-person syndrome (SPS) is a rare autoimmune neurologic disorder that affects the gamma-aminobutyric acid (GABA) mediated inhibitory network in the central nervous system with anti-glutamic acid decarboxylase (GAD) antibodies. SPS is characterized by muscle rigidity and painful episodic spasms in axial and lower limb muscles. This case report describes successful peri-operative management of a 61-year-old female (height, 158 cm; weight, 60 kg, ASA-PS 2) with her right upper arm fracture who was scheduled for open reduction and internal fixation. ⋯ Predonisolone (15 mg) and diazepam (30 mg) was given orally before induction of general anesthesia with propofol, remifentanil and rocuronium bromide. Posture change from supine to beach-chair position led to sudden drop in blood pressure to 38/25 mmHg, which recovered promptly by injecting intravenous ephedrine hydrochloride (28 mg) and hydrocortisone (100 mg). Postanesthetic course was uneventful without postoperative neurologic abnormalities.
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Pulmonary aspiration of gastric or esophageal contents is uncommon; however, it is one of the most severe complications in the perioperative period. The aspiration is associated with possible clinical outcomes, ranging from mild asymptomatic limited episodes of bronchial injury up to the development of a severe acute respiratory distress syndrome. To reduce the incidence of pulmonary aspiration, rapid sequence induction and intubation and awake tracheal intubation are commonly chosen anesthetic techniques for the management of patients at risk of aspiration of gastric or esophageal contents. ⋯ Properly applied techniques are probably effective at preventing regurgitation in the perioperative period although more randomized controlled trials are awaited to confirm this. Pulmonary aspiration should be prevented using multidisciplinary techniques and considerations that have been shown to improve effectiveness of prophylaxes. However, further research is necessary to support this strategy.
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We report a case of vasoplegic syndrome (VS) after aortic valve replacement in a 65 year old male with aortic stenosis. The patient developed hypotension after separation from cardiopulmonary bypass (CPB). Transesophageal echocardiography revealed well-maintained cardiac function and normal prosthetic valve function. ⋯ Hypotension at the time of separation from CPB can be due to multiple factors. Despite an incidence rate of 10%, little is known about VS. We hope that, in future, tailored therapeutic protocols for VS will be developed.