Masui. The Japanese journal of anesthesiology
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Case Reports
[Transient increase of bispectral index in a patient with bronchoconstriction after endotracheal intubation].
A 62-year-old woman (148 cm, 48.5 kg) with a history of bronchial asthma underwent an emergency appendectomy. Ten days before the operation she developed symptoms of wheezing while under asthma medication. An endotracheal tube (7 mm) was inserted after the induction of general anesthesia with intravenous injection of fentanyl 100 micrograms, propofol 100 mg and vecuronium 10 mg under Sellick's maneuver. ⋯ Upon completion of the operation, the endotracheal tube was removed without any events. The patient gave no sign of awareness during the operation. When severe bronchoconstriction prevents the absorption of anesthetics from the lung alveoli, additional intravenous anesthetics should be administered to maintain stable amnesia.
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Case Reports
[Anesthetic management of a patient with olivopontocerebellar atrophy using heart rate variability (HRV)].
A 65-year-old woman with olivopontocerebellar atrophy (OPCA), manifested with cerebellar ataxia mainly, with coexisting impairment of the autonomic nervous system function, and extrapyramidal symptoms, was scheduled for cholecystectomy. With no premedication, anesthesia was induced with sevoflurane and maintained with 1-1.5% of sevoflurane and 66% of nitrous oxide mixed with oxygen. Heart rate variability (HRV) calculated from ECG was used for a monitor of the autonomic nervous system activity. ⋯ We considered that the patient might have postganglionic sympathetic nerve hypersensitivity against inotropic agents. When her blood pressure decreased temporarily after the induction of anesthesia, a bolus dose of ephedrine 1 mg wa given intravenously, which stimulated the sympathetic nervous system indirectly, and could increase her blood pressure. Hypotension during anesthesia in a patient with OPCA with severe autonomic nervous failure was successfully treated by a minimal dose of ephedrine.
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The effect of inhalation induction with sevoflurane on left ventricular(LV) function has not been evaluated in adults. We assessed the effect of inhalation induction with sevoflurane on left ventricular systolic and diastolic function in adult patients using transthoracic echocardiography. ⋯ During inhalation induction with sevoflurane in adult patients, sevoflurane caused negative inotropic effects, but preserved LV diastolic function.
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A 41-year-old woman with single atrium and single ventricle at 6 weeks of gestation was scheduled for dilation and evacuation of the fetus. The PaO2 was 39 mmHg, while she was breathing room air. Dilatation of the uterine cervical canal was performed under spinal anesthesia using 2.0 ml of 0.5% hyperbaric bupivacaine one day before dilatation and evacuation of the fetus. ⋯ However, intravenous fentanyl was needed during the procedure. There was no cardiovascular or respiratory complication after anesthesia and surgery. The patient was discharged on the next day.