Masui. The Japanese journal of anesthesiology
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Comparative Study Clinical Trial
[Preoperative sedation with dexmedetomidine in patients with aneurysmal subarachnoid hemorrhage].
Dexmedetomidine could be beneficial for preoperative sedation of patients with aneurysmal subarachnoid hemorrhage (SAH) because of its sympathetic suppressive effect without respiratory depression. ⋯ Preoperative dexmedetomidine infusion is suitable for patients with SAH.
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In two patients, pheochromocytoma resection was performed under propofol/fentanyl anesthesia, while bispectral index (BIS) monitoring and blood volume measurement using pulse spectrophotometry were done. In one patient (Case 2), arterial blood concentrations of propofol were measured by high performance liquid chromatography (HPLC), and compared with those of the estimated blood concentrations. Continuous infusion of nitroprusside and bolus infusion of nicardipine and/or diltiazem were used when hypertension and tachycardia occurred. ⋯ After tumor resection, the blood pressure was maintained well without rapid infusion of fluid or vasopressor. Arterial blood concentration of propofol was lower than the estimated blood concentration during operation in high blood volume case (Case 2). BIS monitoring and blood volume measurement are useful for adjustment of propofol dosage and for avoidance of hypotension after pheochromocytoma resection.
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We report a case of severe intraoperative pulmonary hypertension during double lung transplantation. A 31-year-old woman with severe primary pulmonary hypertension underwent double lung transplantation. Although a marked increase in pulmonary arterial pressure (180/80 mmHg) exceeding the level of systemic arterial pressure occurred after anesthetic induction, the operation could be performed with scheduled cardiopulmonary bypass without using urgent percutaneous cardiopulmonary support.
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A 57-year-old man with carcinoma of the esophagus was scheduled for a subtotal esophagectomy. We used a bronchial blocker tube to perform one-lung ventilation (OLV). ⋯ When we cannot perform a complete OLV with a bronchial blocker tube, we should consider the possibility of a tracheobronchial anomaly. When one is found in the right superior lobe bronchus, we should use a standard double lumen tube to perform the OLV.
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We experienced a case of fulminant malignant hyperthermia during laparoscopic surgery, which is the first reported case of this kind. A 69-year-old man, weighing 69 kg, underwent laparoscopic colectomy for cecal colon cancer. He had a remarkable familial history of malignant hyperthermia (MH). ⋯ Rise in Paw and arrhythmia turned up frequently as complications of laparoscopic surgery, but they are very similar to the first symptoms of malignant hyperthermia. The decrease in BT with CO2 pneumoperitoneum can mask symptoms of MH. Awareness of this fact is important not to delay the diagnosis.