Masui. The Japanese journal of anesthesiology
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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.
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Randomized Controlled Trial Comparative Study
[Comparison of intraoperative stress hormones release between propofol-remifentanil anesthesia and propofol with epidural anesthesia during gynecological surgery].
Remifentanil recently comes to be used for intraoperative analgesia instead of epidural anesthesia in gynecological surgery. It seems to offer the same stability in vital signs, but stress response during remifentanil anesthesia has not been evaluated. Therefore, we compared remifentanil anesthesia with epidural anesthesia regarding stress hormones. ⋯ The inhibition of stress hormone secretion during operation was less in R than E. Regarding stress response, total intravenous anesthesia with remifentanil seems to be a proper method, but to have less potency than general anesthesia using epidural block.
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As myasthenia gravis affects neuromuscular transmission, these patients show various responses to neuromuscular blocking drugs. We report a successful use of the sugammadex in a myasthenic patient to reverse rocuronium-induced neuromuscular block. ⋯ After spontaneous recovery of T1, we administered sugammadex 200mg intravenously, reversing neuromuscular blockade to a train-of-four ratio (T4/T1) of 100% within 30 sec. Sugammadex can be used to reverse rocuronium-induced neuromuscular blockade in patients with myasthenia gravis, thereby avoiding the need for reversal with acetylcholinesterase inhibitors.
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Case Reports
[Intubating laryngeal mask airway for fiberoptic bronchoscopy in a woman with right bronchial tumor].
A 37-year-old woman with bronchial tumor was scheduled for the removal of the mass with fiberoptic bronchoscope. Intubating laryngeal mask airway (ILMA) was used for fiberoptic surgery. ⋯ Intraoperative laryngospasm was treated with intravenous suxamethonium. The ILMA allowed removal of the bronchial tumor with fiberoptic bronchoscope.
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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.