Masui. The Japanese journal of anesthesiology
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We experienced a case of cesarean section in a patient with a fetus having a prenatally diagnosed huge cervical mass, which could cause airway obstruction immediately after delivery. The fetal cervical mass was confirmed at 19 gestational weeks, and amniocentesis was performed at 33 weeks. At 35 weeks, MRI showed the large mass that could disturb the airway patency after birth, and elective cesarean section was scheduled at 37 weeks. ⋯ After confirming the neonatal oxygenation under manual ventilation, the baby was delivered. After delivery, the mass was diagnosed as cystic hygroma and he was maintained under mechanical ventilation in NICU. Five months later subtotal excision of the cervical cystic hygroma and tracheostomy were performed.
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We managed two patients with secondary hyperthyroidism due to TSH secretion from pituitary adenomas using total intravenous anesthesia with propofol and fentanyl. Both propofol and fentanyl were infused with target-controlled infusion (TCI) systems. The anesthesiologists controlled the target concentration of propofol to maintain the bispectral index (BIS) in a range from 40 to 60, and the target concentration of fentanyl was kept within a range of 2.0 to 3.0 ng.ml-1. ⋯ The necessary concentration of propofol during anesthesia was 2.5 to 4.0 micrograms.ml-1, and the emergence concentration of propofol was 1.4 to 1.7 micrograms.ml-1. These values were almost equal to those obtained in patients without thyroid disease. In conclusion, we could maintain the anesthesia for the patients with hyperthyroidism safely and stably by titrating the concentration of propofol and fentanyl based on the BIS value, and by administrating propranolol and PGE1 to avoid hypertension and tachycardia.
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We report two cases of the rhabdomyolysis of the erector spine muscles occurring after nephrectomy in lateral flexed decubitus position. Case 1. A 39-year-old man (170-cm, 85-kg) underwent right nephrectomy for a right renal tumor. ⋯ Fortunately the patient did not develop renal failure. Direct, prolonged pressure on the paravertebral muscle was the etiology of rhabdomyolysis in our cases. Although our cases were not severe and the complications were not induced, it must be kept in mind that excessive pressure in a limited area can damage the muscle during prolonged surgery.
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A 5-month-old boy was diagnosed as having complete atelectasis of the right lung due to RS virus infection at the age of 1 month. Conventional respiratory physical therapy, inhalation therapy and mechanical ventilation through an endotracheal tube failed to re-expand the right lung, while the left lung gradually became overinflated. We therefore tried differential lung ventilation by using a combination of a laryngeal mask airway and an extra long endotracheal tube (ID, 3.5 mm; length, 280 mm; Portex Pediatric Tracheal Tube, Extra length; SIMS Portex Co., Ltd. ⋯ The right lung was selectively lavaged and inflated with high pressure while ventilation was maintained through the laryngeal mask airway. The SpO2 value was maintained at more than 95% throughout the procedure despite some leakage from the ventilation system. The case demonstrates that differential lung ventilation by use of a combination of a laryngeal mask airway and extra long endotracheal tube is useful for the treatment of a pediatric patient with severe atelectasis.
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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.