Journal of anesthesia
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Journal of anesthesia · Jan 2008
Monitoring of vecuronium-induced neuromuscular blockade during one-lung ventilation.
We investigated the monitoring of neuromuscular blockade caused by vecuronium in patients receiving one-lung ventilation (OLV) anesthesia for lung surgery. ⋯ During OLV for lung surgery, recovery of T1/control is accelerated in anesthetized patients receiving vecuronium.
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Journal of anesthesia · Jan 2008
Case ReportsTotal intravenous anesthesia without muscle relaxant in a patient with amyotrophic lateral sclerosis.
A 63-year-old woman with amyotrophic lateral sclerosis (ALS) was scheduled for open reduction and internal fixation of the right tibia. Total intravenous anesthesia using propofol and remifentanil without muscle relaxant was selected as the anesthetic method, in order to avoid the possible occurrence of ventilatory depression due to abnormal responses to muscle relaxants and exacerbation of the motor neuron disease. ⋯ Intubation was successful and there were no remarkable events during anesthesia, except for three brief hypotensive events; there was no exacerbation of ALS itself during or after the anesthesia. She was discharged on postoperative day 3, without any discomfort.
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Journal of anesthesia · Jan 2008
Case ReportsSpinal epidural hematoma following epidural catheter removal during antiplatelet therapy with cilostazol.
A 90-year-old man underwent emergency thrombectomy for acute occlusion of the right femoral and popliteal arteries. After an epidural catheter (used for intraoperative/postoperative management) was removed, a spinal epidural hematoma involving the Th12 to L3 areas developed. ⋯ This case may be the first report of spinal epidural hematoma associated with both cilostazol and epidural anesthesia. From the time course in this patient, important knowledge of drug actions and follow-up may be gained for determining the timing of catheter removal in a patient receiving antiplatelet therapy with cilostazol.
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Journal of anesthesia · Jan 2008
Case ReportsUnexpected complication of massive intraoperative pulmonary embolism following elective sigmoidectomy in the supine position.
We describe a case of massive intraoperative pulmonary thromboembolism during elective sigmoidectomy in the supine position. During recovery from anesthesia, the patient developed hemodynamic compromise and severe hypoxemia. Intravenous inotropes and mechanical ventilation were instituted. ⋯ Emergent angiography could not be carried out due to the patient's poor clinical status. Lack of experience in performing embolectomy, along with contraindication for thrombolysis, imposed the use of intravenous heparin and hemodynamic support as the only appropriate therapeutic modality. After 2 days' aggressive hemodynamic and ventilatory support, the patient had an uneventful course, and was discharged from the intensive care unit (ICU) 14 days later.
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Journal of anesthesia · Jan 2008
Case ReportsAnesthetic management of a pediatric patient with severe Williams-Campbell syndrome undergoing surgery for giant ovarian tumor.
We performed anesthetic management for a patient with severe Williams-Campbell syndrome, which is a congenital deficiency of cartilage in the subsegmental bronchial tree. An 11-year-old girl with this syndrome had labored breathing because of abdominal distension caused by a giant ovarian tumor, and removal of the tumor was scheduled. Because she had been receiving home oxygen therapy for 10 years due to hypoxia, it was possible that positive-pressure ventilation may have increased the risk of perioperative pulmonary complications. ⋯ We placed an epidural catheter and induced spinal anesthesia blockade under general anesthesia as the main analgesia technique, in order to maintain spontaneous breathing. The surgery was completed uneventfully and the patient emerged from anesthesia without dyspnea. She had an uneventful recovery and was discharged home.