Masui. The Japanese journal of anesthesiology
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Myasthenia gravis (MG) is an autoimmune disease characterized by muscle weakness and fatigability. Women with MG have increased risk of pregnancy-related complications and an adverse pregnancy outcome. Maternal changes in pregnancy can also affect MG. ⋯ In addition to her usual medications, we performed plasmapheresis to improve her condition for the operation not with fresh frozen plasma but with albumin solution just before the operation. No obvious abnormality of coagulation system was observed, and combined spinal and epidural anesthesia was performed with no adverse outcome. We managed her perioperative period free from myasthenic crisis.
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Case Reports
[The use of "laryngospasm notch" in two patients whose oxygen saturations dropped after tracheal extubation].
In 1998, Dr. Larson described the technique of applying pressure to the "laryngospasm notch" as the best treatment for laryngospasm. Yet, there are no case reports of using this technique in the literature. ⋯ In both cases, the patients began to breathe spontaneously shortly after using this technique and oxygen saturation increased to 100%. The incidence of laryngospasm is higher after tracheal extubation. The "laryngospasm notch" method is a good technique to treat this condition.
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Case Reports
[One case of the basilar invagination that prevented tracheal intubation by Airway Scope].
Airway Scope (AWS, Pentax, Tokyo, Japan) is a very useful intubation assistance tool in the case where intubation is difficult with normal Macintosh laryngoscope. In this case, the operation was planned by general anesthesia in a patient with basilar invagination. ⋯ However, glottis was not confirmed even with AWS in the oral cavity, and we could not intubate with AWS. Therefore, we used a fiberscope, and endotracheal intubation was successful.
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A 73-year-old woman with bilateral internal carotid artery stenosis, 80% in the left and 70% in the right, was scheduled for a laparoscopic operation for sigmoidrectal colon cancer. During the operation, general anesthesia was maintained with propofol and fentanyl, combined with epidural analgesia. Regional cerebral oxygen saturation (rSo2) was continuously monitored throughout the operation. ⋯ Thereafter, FIo2 was maintained at 60% and the rSo, was kept at 60% to 70% to the end of the operation. Neurological dysfunctions were not observed after the operation. In order to prevent cerebral ischemic damage from the operation with TP, monitoring of rSo, maybe essential during general anesthesia.
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For more than 20 years morphine for spinal analgesia in patients with refractory cancer pain has been one of the cornerstones for the management of chronic, medically intractable pain. In general, most types of cancer pain are treatable following the guideline of Cancer Pain Relief well established by the WHO. However, some patient are unable to tolerate pain only following the guideline and often suffer with side-effects from high doses of opioid and from prescribed multiple adjuvant drugs. ⋯ Intrathecal drug application is cost effective and can significantly improve the quality of life in selected patients with limited life expectancy. However, an intensive training of physicians, careful patient selection, awareness of specific complications, and arrangement of social back-up medical system are essential to commence intrathecal morphine application using implantable access port. This article introduces the basic idea of intrathecal morphine therapy with implantable access port (not pumps) as cost effective, alternative therapy for cancer patient suffering from intractable pain.