Masui. The Japanese journal of anesthesiology
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We report a case in which two fragments due to coring from the rubbercap of a 50 ml Diprivan vial were detected only immediately before infusion to a patient. The attending anesthesiologist noticed the foreign bodies by chance. ⋯ It is difficult to recognize the small fragments in Diprivan which is white unclear emulsion. Therefore, anesthesiologists should be aware of the danger of coring.
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Arthrogryposis multiplex congenita (AMC) is a syndrome with multiple persistent limb contractures, often accompanied by associated anomalies. Pediatric patients with AMC frequently require operations, necessitating general endotracheal anesthesia. ⋯ Both induction and maintenance were smooth, and no hyperthermia occurred perioperatively. Propofol can be safely used for anesthesia in AMC patients.
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It has been hypothesized that the intubating laryngeal mask (ILM) has some advantages: (1) tracheal intubation is achieved with a neutral head-neck position and limited mouth opening, (2) intubation is not interfered with blood and secretion in the mouth, (3) ventilation via the device is possible, and (4) it is easy to use. Many studies have brought evidences for these points. ⋯ Degree of hemodynamic changes and incidences of postoperative airway complications are similar between the ILM and the laryngoscope. ILM-users should pay attention to these limitations when they use the ILM.
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Case Reports
[Perioperative management using propofol in a patient with uncontrolled preoperative hyperthyroidism].
There is a risk of thyrotoxic crisis during and after surgery in patients with uncontrolled hyperthyroidism. To avoid this, suppression of sympathetic activity during the perioperative period is important. ⋯ Propofol 6 to 8 mg.kg-1.hr-1 plus 66% of nitrous oxide was not sufficient to obtain hemodynamic stability during the surgery, but propofol 3 mg.kg-1.hr-1 produced optimal sedation in the postoperative period. The results demonstrate that propofol is useful for the anesthetic management of patients with uncontrolled hyperthyroidism.
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Case Reports
[Anesthetic management for gastrojejunostomy in a patient with hemiplegia and recurrent laryngeal nerve palsy].
A 70-year-old man who had undergone a low anterior resection for primary rectal cancer 9 years before complained of anorexia, hemiplegia, and recurrent laryngeal nerve palsy. The anorexia was caused by duodenal stenosis due to swollen lymph nodes, the hemiplegia was caused by a metastatic brain tumor, and the recurrent laryngeal nerve palsy was caused by metastases of the cancer to the mediastinal space. ⋯ Thoracic epidural anesthesia could provide sufficient analgesia, and the operation was uneventful. In anesthetic management of an end-stage patient undergoing a palliative operation like this, we should consider the purpose of the operation, its complications, and further complications which may be induced by anesthesia in order to plan out an anesthetic regimen unlikely to lead to harmful events in perioperative period.