Masui. The Japanese journal of anesthesiology
-
Neurological complications related to spinal anesthesia are exceptional, but their consequences are serious. We report a case of conversion disorder, which was initially diagnosed as monoplegia caused by spinal anesthesia. The patient was a 36-year-old, 88 kg woman with a history of psychogenic aphonia. ⋯ The reflexes and muscle's tonus were normal and EMG gave normal findings. The result of neurological diagnosis, confirmed the diagnosis of conversion disorder causing her monoplegia because she was under psychic stressful circumstances from her family. Conversion disorder as a cause of monoplegia after surgery under spinal anesthesia should be kept in mind.
-
Although peripartum cardiac arrest is rare, the prognosis of the event may be worse than in nonpregnant patients because the events is often associated with pulmonary or amniotic embolisms. The following report is a case of cardiac arrest which occurred at the induction of anesthesia for the postpartum hysterectomy. A 31-year-old woman was treated with infusion of ritodrine chloride for preterm labor and placenta previa. ⋯ Since she was not resuscitated with cardiac massage, we started intravenous epinephrine, electronic cardioversion, the percutaneous cardiopulmonary support and intra-aortic balloon pumping with epinephrine and dopamine infusions leading to a successfully outcome. In this case, we believe that the combination of propofol and suxamethonium had the most impact on producing the cardiac arrest. Therefore, the case emphasizes the potential danger of using these combination for patients who have been treated with ritodrine.
-
Case Reports
[Two cases of intraoperative awareness during intravenous anesthesia with propofol in morbidly obese patients].
We experienced two cases of intraoperative awareness during intravenous anesthesia with propofol and fentanyl in morbidly obese patients. The rates of propofol infusion were calculated according to the adjusted body weights, or reduced intentionally as obese patients are generally believed to require lower doses of propofol compared with non-obese patients. Our postoperative analysis by simulations using the anesthesia records showed that, when the simulation was based on real body weight, the blood/effect-site concentrations of propofol in both patients would have been below the necessary levels to keep the patients unconscious during the operation, but when the simulation was based on adjusted body weight, those concentrations might have been within the necessary range to maintain an adequate hypnotic level. We propose that the rate of propofol infusion should be the same in obese and non-obese patients and should be calculated according to the real body weight not to the adjusted body weight.
-
The purpose of this investigation was to determine whether elimination of premedication before general anesthesia affects preoperative anxiety. ⋯ We conclude that elimination of premedication does not increase anxiety in comparison with patients receiving sedatives, but makes patients feel comfortable by way of preoperative conversation. Elimination of premedication also makes ambulatory entrance possible, both improving safety with respect to patient identification and reducing the demand on nursing.