Masui. The Japanese journal of anesthesiology
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A 73-year-old woman (height : 155 cm, weight : 55 kg) was scheduled to undergo a laparotomic hepatectomy and radiofrequency ablation for hepatocellular carcinoma. Her medical history did not include any relevant conditions such as cardiovascular or neurological disorders. A thoracic epidural catheter was introduced at T8-9 before the induction of anesthesia with intravenous propofol. ⋯ A magnetic resonance imaging scan taken on POD4 showed an idiopathic spinal cord infarction (SCI) involving levels T1 through T4, although no epidural abnormalities, e.g., hematomas, were detected. Immediate treatment with methylprednisolone, ozagrel, and edaravone failed to resolve her symptoms. We suggest that it is of great importance to consider SCI as a differential diagnosis as soon as possible in cases of unanticipated postoperative paraplegia.
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Case Reports
[Desflurane Anesthesia in a Morbidly Obese Patient with Severe Obstructive Sleep Apnea].
A 33-year-old morbidly obese patient (body mass index = 59.5 kg x m(-2)) with severe obstructive sleep apnea was scheduled to undergo osteosynthesis of right radial, ulnar and femoral fractures under general anesthesia. Awake intubation under conscious sedation using fantanyl and midazolam was performed by the Pentax-AWS Airwayscope. ⋯ Respiratory depression was minimal during postoperative period. In this case desflurane was safely used in a morbidly obese patient with severe obstructive sleep apnea.
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Case Reports
[Difficult Airway Management of a Patient with the Ossification of Anterior Longitudinal Ligament].
We report a case of difficult airway management (DAM) with the ossification of anterior longitudinal ligament (OALL). A 66-year-old man complained of pharyngeal discomfort. ⋯ We expected DAM due to the limitation of cervical mobility and airway obstruction caused by OALL. We succeeded in awake intubation with video laryngoscope and tracheal tube introducer.
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Case Reports
[Two Separate Instances of Anesthetic Management in a Patient Initially Diagnosed with Stiff-person Syndrome].
In this case report, we describe separate instances of general anesthetic management administered to a patient during treatment for two unrelated conditions. The patient, a 57-year-old woman who had been experiencing walking difficulties for about four years, fell down because of muscle rigidity and spasms and fractured her humerus. She was subsequently diagnosed with stiff-person syndrome. ⋯ No prolonged effect of the muscle relaxant or any autonomic reactions were observed. The patient was fully conscious and in good respiratory condition after both surgeries, and was extubated in the operating room. There were no perioperative complications.
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With the advance of diagnosis and therapeutic management for congenital heart disease, increasing numbers of the non-cardiac surgery were performed on patients with post-cardiac surgery, such as the radical operations and Fontan operation. However, there are adult patients who have not received Fontan operation lacking indication. We experienced a case of adult surgical patient for laparoscopic cholecystectomy complicated with tricuspid atresia who was not indicated for Fontan surgery. ⋯ To reduce the influence of intraabdominal pressue on hemodynamics, the insufflations pressure was maintained at 8 mmHg during pneumoperitoneum. To assist ventricular function, dopamine and carperitide were administered perioperatively. We should carefully manage such a patient during perioperative period by understanding the hemodynamic state and considering the influence of pneumoperitoneum and posture.