Masui. The Japanese journal of anesthesiology
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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.
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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.
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A 43-year-old man (166 cm, 53.5 kg) with cerebral palsy on maintenance hemodialysis underwent a right nephrectomy for gross hematuria under combined spinal-epidural anesthesia (CSEA) with sedation. The patient suffered from hemiplegia, speech disturbance and low intelligence (approximately 6 years and 8 months). Following premedication with midazolam 4 mg, he was calm and cooperative. ⋯ Three hours after surgery, sleep was induced by brotizolam 0.25 mg orally. We accomplished a giant nephrectomy under CSEA with sedation in a patient with cerebral palsy receiving hemodialysis. Sufficient premedication using midazolam was profitable for CSEA in mental-retarded patient.
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A 71-year-old man with a history of allergic rhinitis for 6 years received spinal anesthesia using 2 ml of 0.3% dibucaine for transurethral prostatectomy. Two months previously he had undergone prostate biopsy and cystoscopy under spinal anesthesia with isobaric bupivacaine uneventfully. Forty five minutes after injection of dibucaine he complained of itching in the periorbital area, and developed tremor and muscle rigidity followed by loss of consciousness. ⋯ Continuous infusion of epinephrine was needed for complete relief of symptoms. An intradermal test with 0.3% dibucaine carried out 6 days after surgery demonstrated a 12 x 8 mm wheal with flare. Although anaphylactic reaction to an amide local anesthetic has been reported to be quite rare, this is the 7th case report of anaphylactic reaction to dibucaine used for spinal anesthesia in Japan.
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Young-Simpson syndrome (YSS) is a rare malformation syndrome characterized peculiar facies, congenital hypothyroidism, congenital heart disease, and postnatal growth deficiency. A 3-year-old boy with YSS underwent tracheostomy for respiratory failure under general anesthesia using sevoflurane, nitrous oxide and oxygen. Although he was assumed to be difficult for intubation due to micrognathia and macroglossia, tracheal intubation was done without difficulty. No complications were observed during the 40 minutes of the operation.