Masui. The Japanese journal of anesthesiology
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Case Reports
[Interscalene block combined with general anesthesia under spontaneous breathing in a patient with a giant bulla].
Respiratory management for patients with a giant bulla during anesthesia should avoid positive-pressure ventilation to reduce the risk of barotraumas. We report a case of anesthetic management of a 42-year-old man with a giant bulla who had an elective surgery for biopsy of a tumor on his left elbow. Balanced anesthesia consisting of general anesthesia was given under spontaneous breathing combined with interscalene brachial plexus blockade for intra- and postoperative analgesia for the elbow surgery. ⋯ The airway was maintained with a size 4 LMA-Proseal, which was inserted with care under spontaneous breathing. There were no serious complications such as pneumothorax in perioperative period. We performed successful anesthetic management, without any complications, combined with interscalene brachial plexus block and spontaneous breathing in a patient with a giant bulla.
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Case Reports
[Administration of sugammadex to a patient with myasthenia gravis with fade of the train-of-four ratio].
A 50-year-old man (weight 87 kg, height 171 cm) with myasthenia gravis (MG) was scheduled for extended thymectomy under general anesthesia. His preanesthetic train-of-four ratio (T4/T1) was 59%. The first twitch of the train-of-four (T1) was 130% after calibration. ⋯ After 5 min, T4/T1 had reached 54%, but T1 had not reached the control value; therefore, we administered additional 1.5 m x kg(-1) of sugammadex. Subsequently, T1 reached 120%. Patients with MG with fade on T4/T1 require a full dose of sugammadex, identical to the dose administered to normal patients.
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We experienced pheochromocytoma resection and coronary artery bypass grafting under cardiopulmonary bypass (CPB). The patient was a 69-year-old man who was first diagnosed with atherosclerotic angina. During operation, his blood pressure increased at induction and manipulation of the tumor under CPB, associated with an increased serum noradrenaline concentration. ⋯ Surgical and hemodynamic management was facilitated by TEE. TEE was useful to make a diagnosis of cardiac pheochromocytoma, to determine the area of resection, to determine the surgical repair, and to make a decision of hemodynamic management in this complicated patient. We suggest that perfoming these cases under CPB and TEE is recommended for stabilization of hemodynamic states.
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A 58-year-old man with hypertension underwent laparoscopic distal gastrectomy under general and epidural anesthesia. Preoperative laboratory date revealed a normal platelet count and normal coagulation profile. Epidural puncture was successfully performed at the T9-10 intervertebral space on the first attempt without bleeding. ⋯ Ten minutes later, paraplegia disappeared spontaneously. It is suggested that the spinal cord of the patient was subjected to transient pressure hematoma. A decline in blood pressure may have caused the blood to spread through the epidural space, such that the neurologic symptoms disappeared.
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The effect of interscalene block on postoperative pain after arthroscopic rotator cuff reconstruction (ARCR) was evaluated. ⋯ Single-shot interscalene block with less than 10 ml of ropivacaine before ARCR reduced postoperative pain only for several hours after the operation.