Masui. The Japanese journal of anesthesiology
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In two patients, pheochromocytoma resection was performed under propofol/fentanyl anesthesia, while bispectral index (BIS) monitoring and blood volume measurement using pulse spectrophotometry were done. In one patient (Case 2), arterial blood concentrations of propofol were measured by high performance liquid chromatography (HPLC), and compared with those of the estimated blood concentrations. Continuous infusion of nitroprusside and bolus infusion of nicardipine and/or diltiazem were used when hypertension and tachycardia occurred. ⋯ After tumor resection, the blood pressure was maintained well without rapid infusion of fluid or vasopressor. Arterial blood concentration of propofol was lower than the estimated blood concentration during operation in high blood volume case (Case 2). BIS monitoring and blood volume measurement are useful for adjustment of propofol dosage and for avoidance of hypotension after pheochromocytoma resection.
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We report a case of severe intraoperative pulmonary hypertension during double lung transplantation. A 31-year-old woman with severe primary pulmonary hypertension underwent double lung transplantation. Although a marked increase in pulmonary arterial pressure (180/80 mmHg) exceeding the level of systemic arterial pressure occurred after anesthetic induction, the operation could be performed with scheduled cardiopulmonary bypass without using urgent percutaneous cardiopulmonary support.
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A 57-year-old man with carcinoma of the esophagus was scheduled for a subtotal esophagectomy. We used a bronchial blocker tube to perform one-lung ventilation (OLV). ⋯ When we cannot perform a complete OLV with a bronchial blocker tube, we should consider the possibility of a tracheobronchial anomaly. When one is found in the right superior lobe bronchus, we should use a standard double lumen tube to perform the OLV.
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Case Reports
[Ilioinguinal nerve block during general anesthesia for inguinal herniorrhaphy in adult anticoagulated patients].
Two adult anticoagulated patients after valve replacement were scheduled for inguinal herniorrhaphy. For inguinal herniorrhaphy in adults, spinal anesthesia is a common anesthetic method. In order to avoid spinal hematoma due to spinal anesthesia, however, we employed general anesthesia combined with ilioinguinal nerve block. ⋯ Ilioinguinal nerve block was performed with 0.25% bupivacaine 20ml. Ilioinguinal nerve block was effective for maintaining hemodynamic stability throughout the operation, and decreased postoperative pain. This technique appears to be a simple and safe method for providing effective and long-lasting perioperative analgesia following inguinal herniorrhaphy in adult patients.
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We experienced a case of fulminant malignant hyperthermia during laparoscopic surgery, which is the first reported case of this kind. A 69-year-old man, weighing 69 kg, underwent laparoscopic colectomy for cecal colon cancer. He had a remarkable familial history of malignant hyperthermia (MH). ⋯ Rise in Paw and arrhythmia turned up frequently as complications of laparoscopic surgery, but they are very similar to the first symptoms of malignant hyperthermia. The decrease in BT with CO2 pneumoperitoneum can mask symptoms of MH. Awareness of this fact is important not to delay the diagnosis.