Masui. The Japanese journal of anesthesiology
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We report a successful electrocorticography (ECoG) monitoring for a epileptic cortical focus resection in a 9-month-old girl with uncontrollable epileptic seizures. Anesthesia was induced and maintained with nitrous oxide, oxygen, and sevoflurane with vecuronium. ⋯ It was necessary to maintain adequate depth of anesthesia throughout the procedure to clarify the epileptic waves. For this purpose, sevoflurane (2.5%) with and oxygen (97.5%) under controlled-hyperventilation (PaCO2 30 mmHg), was useful for monitoring the epileptic seizure wave from cortical focuses properly.
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Fracture of the femoral neck (FNF) is a significant cause of morbidity and mortality in the elderly, and the elderly with FNF are often high-risk patients for anesthesia. We studied 15 patients above 80 years of age with severe physical status (ASA III-IV). ⋯ After the operation, morphine 2 mg was administered subcutaneously. In our experience, the majority of 15 patients cardiovascular status of remained stable, except one patient who needed ephedrine for hypotension and another patient who needed diclofenac sodium for post-operative pain relief.
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Case Reports
[An anesthetic experience of a patient with subacute myelo-optico-neuropathy for bilateral mastectomy].
A 79-year-old woman with subacute myelo-optico-neuropathy (SMON) underwent a bilateral mastectomy for breast cancer. She has been suffering from SMON for 32 years. Her preoperative neurological examination revealed cryesthesia and dyskinesia in the lower extremity, and numbness in the crues. ⋯ A combination of general anesthesia and epidural block was employed to minimize the dose of anesthetics which may affect the neuronal symptoms. Intraoperative course was uneventful and continuous epidural block was effective for postoperative pain control. There was no neurological deterioration postoperatively.
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Comparative Study Clinical Trial
[Utility of Ringer's acetate solution as an intraoperative fluid during cardiovascular surgery with cardiopulmonary bypass].
This study aimed to clarify the difference in the effects of Ringer's acetate (AR) and Ringer's lactate (LR) administration during cardiovascular surgery with cardiopulmonary bypass. We evaluated their effects on intra and postoperative metabolism, liver functions, blood gas and hemodynamic states. Twenty patients were divided into two groups; AR group (n = 10) and LR group (n = 10). ⋯ It has been reported that acetate has a greater vasodialatory effect than lactate. However, our findings indicate no significant difference in hemodynamics between the two groups. These results suggest that AR may be more useful than LR during cardiovascular surgery with cardiopulmonary bypass.
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Case Reports
[Intraoperative hemodilutional autotransfusion using a closed circuit for patients of Jehovah's Witness].
We conducted hemodilutional autotransfusion using a closed circuit combined with a cell washing reinfusing system (Cell Saver) for two surgical patients of Jehovah's Witness. One was a 12 yr-old boy for extirpation of the teratoma in the anterior mediastinum and another was a 44 yr-old woman for left total hip replacement. The patients and their relatives had consented to the use of blood substitutes, hemodilutional autotransfusion using a closed circuit and Cell Saver. ⋯ Blood collected from the surgical field by Cell Saver was also led to the bag. Acid citrate dextrose solution was infused into the closed circuit from the site close to the blood drawing. Both of our surgical patients were safely managed without homologus blood transfusion, although there remained some problems concerning the use of anticoagulants.