Masui. The Japanese journal of anesthesiology
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We experienced anesthetic management of two cases of amyotrophic lateral sclerosis (ALS). Case 1. A 46-year-old woman underwent emergency operation for ileus. ⋯ During and after the operation, she was in good general condition and had no pain. For the patients with ALS, prolongation of muscle relaxation and residual neuromuscular block effect may cause difficult tracheal extubation and postoperative respiratory complications. We observed carefully the condition of the patients with ALS, and were able to choose the minimum invasive anesthetic methods for each case.
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We experienced an anesthetic management for a patient of myotonic dystrophy with pheochromocytoma. Much attention is required to manage myotonic dystrophy on surgical manipulation. This disease interacts with anesthetic drugs. ⋯ Though, this patient was not fully awake from anesthesia and could not take enough breaths on his own. We extended the period of spontaneous breathing with careful check whether the patient has resumed spontaneous breathing. It took us fourteen days till extubation.
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We recently had opportunities to use an improved bronchial blocker (Phycon TCB bronchial blocker) in surgical patients who needed separation of the lungs and/or one-lung ventilation. This blocker provides a high torque control and can be easily manipulated into the desired site of the lungs. Our clinical experience shows that this blocker is useful particularly when the quick and sure separation of the lungs is crucial or when the insertion of a double-lumen tube is very difficult.