Masui. The Japanese journal of anesthesiology
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A 55-year-old male with Lambert-Eaton myasthenic syndrome underwent low anterior resection. Before anesthetic induction, his arterial blood gas analysis showed chronic hypercapnia (pH 7.404, Paco2 59 mmHg, BE 9.1). Anesthesia was induced with propofol, remifentanil and ketamine. ⋯ Good surgical condition was maintained even without using muscle relaxants. Although only a small amount of morphine was required during the early postoperative days, his postoperative course was smooth and uneventful. The present case shows that ultrasound-guided rectus sheath block and transversus abdominis plane block are safe and useful for abdominal surgery in patients with neuromuscular disease.
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Case Reports
[Epidural anesthesia for femoral head replacement in a spinocerebellar ataxia patient: a case report].
Perioperative management of a spinocerebellar ataxia patient by epidural anesthesia is reported. A 67-year-old woman with left femur neck fracture underwent femoral head replacement. An epidural catheter was placed without difficulty at the L3-4 interspace using the loss of resistance technique. ⋯ Overall, hemodynamics and respiratory status were stable. Postoperative analgesia was maintained by infusion of 0.2% ropivacaine at 2 ml x hr(-1). The patient's postoperative course was uneventful, and her neurologic conditions remained unchanged.
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Spinal anesthesia was attempted in a 21-year-old woman for acute cesarean section with lumbar puncture at L3-4 and L4-5 in another hospital, but it was abandoned after more than 10 attempts because no cerebrospinal fluid (CSF) was seen flowing. She was transferred to our hospital, and we attempted spinal anesthesia at L2-3 and CSF was seen flowing. ⋯ Surgery proceeded uneventfully. There were no postoperative neurological complications related to spinal anesthesia.
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We report a case of successful fiberoptic tracheal intubation through the supraglottic airway device air-Q in a 14-year-old boy in whom intubation was difficult because of Shprintzen-Goldberg syndrome. Shprintzen-Goldberg syndrome is a rare congenital disorder of connective tissue. ⋯ Fiberoptic tracheal intubation through the air-Q was successfully performed without any difficulty and was safe for his weak airway connective tissue. Supraglottic airway air-Q is a useful conduit for fiberoptic tracheal intubation under general anesthesia, especially in the case of a patient with weak connective tissue in whom intubation is difficult.
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We retrospectively examined the transversus abdominis plane (TAP) block performed in 8 infants (range, 1-115 days) from July 2010 to March 2011. Ultrasound images clearly visualized the fascial plane between the transversus abdominis and the internal oblique muscle and it was possible to confirm proper administration of local anesthetics into the plane in all patients. ⋯ Another infant developed delayed emergence from anesthesia. We should tailor the dose of systemic opioid, considering the fact that the simultaneous administration of nerve block and systemic opioids may cause sedation and respiratory depression in young infants.