Masui. The Japanese journal of anesthesiology
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We experienced two cases of anaphylaxis during anesthesia using rocuronium in two months. In both cases, we carried out intradermal test and positive reaction occurred with rocuronium. In both cases, the second anesthesia without neuromuscular blockade was uneventful. Though it is difficult to diagnose anaphylaxis, we should suspect anaphylaxis when cardiovascular collapse, bronchospasm and/or dermal symptoms occur after induction of anesthesia.
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Case Reports
[Arytenoid cartilage dislocation caused by endotracheal intubation which resolved spontaneously].
Arytenoid cartilage dislocation following tracheal intubation is a rare complication. A 48-year-old man underwent an operation for laparoscopic cholecystectomy under general anesthesia. Although no anaesthetic or operative problem had occurred, hoarseness was noticed after the operation, continuing beyond 25 days thereafter. ⋯ About four weeks later, the arytenoid cartilage dislocation resolved spontaneously. Other findings suggest that spontaneous reduction can be expected in many patients with anterior arytenoid dislocation. Patients suffering from arytenoid cartilage dislocation should be observed for several weeks if possible because there exist some reports in the literature describing spontaneous resolution after its dislocation.
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We report a pregnant woman who developed non-traumatic spinal subdural and epidural hematoma. A 31-year-old woman at 28 weeks of gestation developed progressive ascending paralysis. ⋯ An emergency cesarean section followed by spinal decompression was performed 60 hours after the onset. The patient's neulogical function recovered completely after the surgey.
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Two patients with myasthenia gravis were scheduled for surgery. Anesthesia was managed with remifentanil and propofol target-controlled infusion without the use of muscle relaxants. ⋯ Throughout the surgery, muscle relaxants were not required. Thus, the use of these drugs for inducing anesthesia provided good conditions for tracheal intubation and surgery, and it precluded the need for muscle relaxants.
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Primary tracheal cancer is extremely rare, but critical tracheal stenosis is seen in many cases. Although laser resection or stent placement is performed under general anesthesia, anesthetic management for tracheal tumor is extremely difficult in terms of airway management. We report a 65-year-old woman scheduled to undergo bronchoscopic laser surgery and insertion of Dumon stent for tracheal tumor which severely obstructed the upper airway. ⋯ Although desaturation due to unsuccessful venous drainage and difficult ventilation by laryngeal edema during the operation and tracheal obstruction by a clot after the operation was observed, the patient's clinical condition improved. In cases of severe tracheal stenosis, airway obstruction by hemorrhage, secretion and laryngeal edema, etc. occur easily. Therefore, some kind of measures should be taken for the operation and a number of precautions must be taken during the perioperative period.