Masui. The Japanese journal of anesthesiology
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Case Reports
[Postoperative continuous epidural infusion of morphine in a patient with myotonic dystrophy].
Patients with myotonic dystrophy present potential problems during and after anesthesia, especially respiratory dysfunction. A 42-year-old female with myotonic dystrophy associated with slight impairment of respiratory functions and muscular power, underwent abdominal total hysterectomy under epidural anesthesia uneventfully. ⋯ She obtained adequate analgesia after the surgery without respiratory depression or other major complications. We demonstrated that the continuous epidural infusion of morphine in a patient with myotonic dystrophy is safe and adequate for postoperative pain relief.
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Case Reports
[Anesthesia for bilateral volume reduction surgery in a patient with severe bullous emphysema].
An 80-year-old male with severe bullous emphysema underwent bilateral volume reduction surgery. He had suffered from dyspnea and was classified into Hugh-Jones III. In spirogram, forced vital capacity in 1 second was markedly low (0.38 l, corresponding to 19.4 % in % FEV1.0). ⋯ We used a critical care type ventilator (Servo 900C, Simens) for pressure controlled ventilation for fear that positive pressuse ventilation creates or aggravates airleaks. Surgery and anesthesia were performed uneventfully. We recommend lower concentration of a volatile agent combine with thoracic epidural analgesia and pressure controlled ventilation for the volume reduction surgery.
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We experienced delayed rupture of a balloon reservoir in a disposable infusion pump 3 hours after filling. The investigation revealed a sharp scratch in the reservoir. Furthermore, as we did not filtrate the drugs before filling, we speculate that ampule fragments could have provoked the rupture. When filling a disposable infusion pump with ampule solution, filtration against glass contamination is recommended.
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We evaluated clinical efficacy of near infrared spectroscopy (NIR) as a monitoring system for cerebral oxygenation during anesthesia for carotid artery endarterectomy. NIR proved to be affected significantly by clamping of the external carotid artery. The present study suggests that this monitoring system may be useful for evaluation of cerebral blood flow following declamping of the internal carotid artery, although it has some limitations during clamping of the artery.
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Case Reports
[Rhabdomyolysis induced by succinylcholine chloride and sevoflurane in an elderly man].
An 81-year-old man was scheduled for cervical lymph node biopsy. His laboratory data were within normal ranges. After induction of anesthesia with thiopental 175 mg and succinylcholine chloride (SCC) 40 mg, moderate masseter spasm was observed. ⋯ The skinned fiber examination, performed one month later, showed his calcium-induced-calcium-release (CICR) to be within normal ranges. We diagnosed him as rhabdomyolysis induced by coadministration of SCC and sevoflurane, especially SCC. We concluded that even in an elderly man, SCC should be administered cautiously.