Masui. The Japanese journal of anesthesiology
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We experienced a patient with respiratory insufficiency after resection of the aortic aneurysm and replacement with a synthetic conduit which recovered by airway pressure release ventilation (APRV) dramatically. A 44-year-old man diagnosed as aortic aneurysm of the descending thoracic aorta was admitted to our hospital and an operation was scheduled. The operation lasted for 19 hours and the time of general anesthesia was 23 hours. ⋯ Additionally, oxygenation was improved. He was weaned from a ventilator on postoperative day 5. We have demonstrated that APRV is an important tool that should be used to improve severe respiratory insufficiency.
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The Japanese Society of Anesthesiologists (JSA) has investigated the incidence of postoperative pulmonary thromboembolism (PTE) for several years. ⋯ Our data suggest that the actual incidence of postoperative PTE in Japan may be far greater than that reported by the JSA.
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We report a case of thoracoscopic pulmonary resection for pneumothorax in a patient with Becker muscular dystrophy The sensitivity of nondepolarizing muscle relaxant in a patient with muscle dystrophy is reportedly higher than in a patient without muscle disease, and the duration of the effect is known to be prolonged. In a 26-year-old man (height 160 cm, weight 39 kg) with Becker muscular dystrophy, general anesthesia was induced with target controlled infusion of propofol (3.0 microg x ml(-1)) and 0.4 microg x kg(-1) of min(-1) of remifentanil. A small amount of rocuronium was also administered additionally until TOF ratio reached to 0%. ⋯ The duration of surgery was 68 min. We confirmed 84% recovery of TOF ratio 90 min after injection of rocuronium, and extubated the patient without reversal of rocuronium. We found that the maximum concentration in the plasma or effective site (Cp/Ce) of rocuronium was reached at the time of intubation.
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We report a case where "laryngospasm notch" technique was used in a patient to initiate spontaneous respiration during general anesthesia. The patient was a 43-year-old woman who underwent conization. A Pro-Seal laryngeal mask airway was inserted after induction of general anesthesia. ⋯ Surgical course was uneventful until the patient became unable to breathe towards the end of surgery. Positive-pressure ventilation was applied, but the patient could not be ventilated. "Laryngospasm notch" technique was performed by applying digital pressure in front of the tragus of the ears, and the patient began to breathe spontaneously. We describe our experience with the "laryngospasm notch" technique applied to the front of the tragus of the ears to treat laryngospasm.
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We report a case of a 3-year-old boy who had undergone total cavopulmonary connection for repair of corrected transposition of the great arteries (cTGA), and developed intractable supraventricular tachyarrhythmia. The patient was in cardiogenic shock and did not respond to antiarrhythmic drugs and cardioversion, and we used extracorporeal life support (ECLS) to maintain hemodynamics. ⋯ No recurrence was observed. In conclusion, dexmedetomidine might be useful for intractable supraventricular tachyarrhythmia after pediatric congenital heart surgery.