Masui. The Japanese journal of anesthesiology
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We report a case of delayed awakening with characteristic repeated loss of consciousness after remifentanil infusion complicated by leakage from an intravenous catheter. A 30-year-old male underwent microlaryngeal surgery for a vocal cord polyp. During anesthetic induction, infiltration from an intravenous (IV) line in the left forearm was observed 10 min after initiating a continuous infusion of remifentanil 0.5 microg x kg-1 x min -1. ⋯ Blood gases, electrolytes, glucose values, and body temperature were within normal ranges throughout the perioperative period. Brain computed tomography, mag- netic resonance imaging, and electroencephalography showed no abnormalities. It was considered that the incidental subcutaneous remifentanil accumulation may have caused the respiratory suppression and delayed awakening.
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We experienced management of general anesthesia in a patients with Coffin-Siris syndrome (CS syndrome) which is an autosomal dominant disorder characterized by mental retardation, growth failure, hypoplasia of the fifth finger's distal phalanx and limb, and syndrome-specific facial appearance. Anesthesia was induced by sevoflurane by mask. ⋯ Surgical procedures and anes-thetic management were performed uneventfully. This case demonstrates usefulness of AWS in pediatric patients with difficult intubation.
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The definition of acute respiratory distress syndrome (ARDS) by American-European Consensus Conference (AECC) in 1994 has promoted clinical and epidemiological research leading to improved survival outcome of the ARDS patients by establishing lung protective ventilation. On the other hand, no pharmacological therapy has yet proved to be effective despite substantial effort devoted to development and research. ⋯ Recently, a randomized trial and clinical experience in treating severe influenza have demonstrated favorable outcome of ECMO therapy in the management of severe ARDS. Future progress will depend on developing novel therapeutics that can ameliorate lung injury and systemic derangements and facilitate lung repair.
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We report that the transversus abdominis plane block (TAP block) can be performed under ultrasound guidance using not a linear probe but a convex probe in a markedly obese patient undergoing laparoscopy-assisted distal gastrectomy. The TAP block is effective for providing perioperative analgesia. ⋯ We used a low-frequency convex probe for TAP block, which clearly showed the spread of local anesthetics in TAP block in a markedly obese patient. A convex probe is preferable for TAP block in markedly obese patients.
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Case Reports
[A case of prolonged neuromuscular blockade possibly related to a high anti-acetylcholine receptor antibody level].
Prolonged neuromuscular blockade is a relatively common complication of general anesthesia. Some previous reports have shown that positive serum anti-acetylcholine receptor antibody (AChR Ab) might contribute to this complication. ⋯ Although this patient had mediastinal tumor diagnosed as thymic carcinoma two years before the operation, preoperative clinical evaluation was negative for myasthenia gravis (MG) and the tumor was in remission at the operation. These observations suggest that preoperative measurement of anti-AChR Ab level might be recommended for patients with mediastinal tumor regardless of symptoms of MG and that neuromuscular blocking agents should be administrated carefully in anti-AChR Ab positive patients under monitoring of the neuromuscular blockade.