Masui. The Japanese journal of anesthesiology
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Peripartum cardiomyopathy (PPCM) is a rare life-threatening cardiomyopathy of unknown cause that occurs in the peripartum period in previously healthy women, and is becoming the leading cause of maternal death in U. S. ⋯ Anesthesiologists are supposed to be involved in the deliveries of those parturients with PPCM by providing labor analgesia, anesthesia for cesarean section and for heart transplantation. For cesarean section, either regional anesthesia or general anesthesia can be chosen, but low dose combined spinal-epidural analgesia has been reported to be a reliable choice.
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A 63-year-old man with von Recklinghausen disease was transported to the emergency department for swelling and pain of his right neck. Chest X-ray and computed tomography scan showed displacement of the trachea to the left by a tumor mass. Urgent airway management was required and fiberoptic intubation in awake condition was planned. ⋯ Suddenly, his consciousness level and Sp(O2) went down, therefore surgical airway was required. Due to pre-scanning, emergency cricothyroid membrane puncture could be performed immediately without any complications. We recommend ultrasound pre-scanning for cricothyroid membrane puncture in a patient with suspected tracheal displacement.
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Arrhythmogenic right ventricular cardiomyopathy is a genetic cardiomyopathy characterized by replacement of right ventricular myocardium by fibrofatty infiltrates, leading to significant ventricular arrhythmias with sudden death and right ventricular dysfunction. Elective operations should be postponed, until the arrhythmias and myocardial function are well tolerated. There has been no guideline on the anesthetic management of this serious, despite rare, disease and there are a few reports of the patients undergoing operation under either general or regional anesthesia. ⋯ It is essential to apply alpha-adrenergic agonists instead of beta-agonists for intraoperative hemodynamic support. The arrhythmias should be managed with beta-blockers or amiodarone. Adequate control of postoperative analgesia and nausea/vomiting is also important to suppress sympathetic activities.