Masui. The Japanese journal of anesthesiology
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A 35-year-old pregnant woman (weight, 129.5 kg; height, 156 cm; 37 weeks of pregnancy) with a body mass index of 53 was scheduled for a cesarean section. It was thought that epidural or spinal anesthesia might result in complications due to her severe obesity. It was therefore decided to use general anesthesia following awake intubation. ⋯ During surgery, she developed hypoxia due to upper shift of the diaphragm. After surgery, she was extubated after improvement of her oxygenation under spontaneous breathing. This case demonstrates that difficulties may be encountered during anesthetic management of a severely obese patient undergoing cesarean section.
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Laparoscopic procedures are considered relatively low-invasive. However, there exists a small but important risk of developing complications related to carbon dioxide (CO2) insufflation. End-tidal CO2 (PetCO2) monitoring may not be a sufficient guide to adjust pulmonary ventilation during laparoscopic surgery, and arterial CO2 (PaCO2) monitoring is not always indicated. We evaluated the accuracy and feasibility of transcutaneous CO2 (PtcCO2) monitoring during laparoscopic surgery. ⋯ The transcutaneous devices provide an effective method for non-invasive monitoring of PCO2 in situations where continuous monitoring of CO2 levels is desired such as peri-operative period of laparoscopic surgery.
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Case Reports
[False decrease in pulse oximetry readings due to patent blue in a patient with breast cancer].
A 61-year-old woman with breast cancer was scheduled for breast preserving therapy under general anesthesia. After the tracheal intubation, 4 ml of 2% patent blue was injected into the skin to determine sentinel lymph node. Thirty seconds after injection, the pulse oximetry reading (SpO2) decreased from 100% to 60% and recovered to 90% over the next 5 minutes. ⋯ The operation was completed uneventfully and the patient recovered from anesthesia smoothly. After extubation, arterial blood gas analysis was performed again and it showed PaO2 of 82.5 mmHg (FIO2 0.21). We conclude that patent blue injection caused this decrease in SpO2 and recommend to evaluate the oxygen status not only by pulse oximetry but also by blood gas analysis when patent blue is used.
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Case Reports
[Anesthetic management for cerebral aneurysm surgery in a patient with aortitis syndrome accompanied by lung edema].
A 48-year-old woman with aortitis syndrome underwent clipping of dissecting aneurysm of the left posterior inferior cerebellar artery following subarachnoid hemorrhage. Preoperative echocardiography demonstrated moderate aortic regurgitation and pulmonary hypertension. Intravenous infusion (1900 ml.day-1) was performed to avoid cerebral vasospasm, but the patient developed lung edema. ⋯ Anesthesia was maintained with sevoflurane, air, and oxygen. We continuously monitored the central venous pressure as an indicator of fluid balance. In this case, we monitored dorsal pedis arterial pressure directly, which might not be sufficiently reliable to predict the decrease in cerebral blood flow.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Postoperative analgesia using continuous lumbar epidural infusion of ropivacaine in comparison with bupivacaine].
Epidural bupivacaine infusion is a commonly used technique for postoperative analgesia because of its motor-sparing properties. Recently a new long acting local anesthetic, ropivacaine, has become available. The aim of this study was to investigate the efficacy of ropivacaine and bupivacaine with regard to postoperative analgesia when administered continuously into the lumbar epidural space. ⋯ After leg orthopedic surgery, 6 ml.hr-1 of 0.2 R or 0.125 B provided enough postoperative analgesia when the spread of anesthesia covered the operated area. 0.2 R would be better compared to 0.125 B in continuous epidural infusion for postoperative analgesia due to less systemic toxicity, even though it accompanies a little more intense motor block.