Masui. The Japanese journal of anesthesiology
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A 47-year-old woman with postdural puncture headache suffered from transient paralysis and paresthesia immediately after the epidural blood patch. After one and a half hour, these symptoms disappeared spontaneously. ⋯ With passing of time, the viscous blood spread through the epidural space, and neurological symptoms improved. Although the risks of epidural blood patch are relatively low, we should closely pay attention to unexpected side effects.
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A 64-year-old woman with hypertension, diabetes mellitus and asymptomatic first degree AV block underwent low anterior resection of the rectum. Anesthesia was induced with propofol, vecuronium bromide and remifentanil and maintained with nitrous oxide in oxygen, propofol and remifentanil. We did not use epidural anesthesia. ⋯ The EKG changed from first degree AV block to second degree AV block followed by complete AV block and finally cardiac arrest. As soon as we performed heart massage, sinus rhythm appeared. We should be careful in giving dexmedetomidine to a patient with AV block.
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We encountered a 53-year-old woman with myotonic dystrophy for a total abdominal hysterectomy. In patients with myotonic dystrophy, hypersensitivity to anesthetic drugs, especially muscle relaxants and opioids, may complicate postoperative management. Combined spinal and epidural block was used in this patient to prevent the occurrence of potential postoperative complications associated with general anesthesia, including respiratory depression. ⋯ Airway obstruction was observed after the initial administration of dexmedetomidine at 2 microg x kg(-1) x hr(-1). Therefore, the dose of the drug was reduced to a maintenance dose of 0.2% microg x kg(-1) x hr(-1), resulting in adequate sedation. Dexmedetomidine was proved to be useful in this case; however, use of the drug should be carefully started at a low initial dose in patients with myotonic dystrophy.
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Case Reports
[Anesthetic management of caesarean section following the Fontan procedure by using TaskForce Monitor].
The Fontan procedure is performed for patients with a corrected transposition of great arteries, and pregnancies following this surgery are likely to increase in number. We present a parturient with the Fontan physiology. In this case, we used thoracic bio-impedance cardiac output monitoring system "TaskForce Monitor". It was shown that the cardiovascular management by using TaskForce Monitor was useful because of the non-invasive beat-to-beat cardiac output monitoring.
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This report shows a rare case of muscle rigidity by remifentanil just before the end of surgery. A 71-year-old man was scheduled for microvascular decompression to cure trigeminal neuralgia. ⋯ After giving muscle relaxants, the patient was uneventful. We should pay attention to muscle rigidity even using low doses of remifentanil.