Masui. The Japanese journal of anesthesiology
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Case Reports
[A case of prolonged neuromuscular blockade possibly related to a high anti-acetylcholine receptor antibody level].
Prolonged neuromuscular blockade is a relatively common complication of general anesthesia. Some previous reports have shown that positive serum anti-acetylcholine receptor antibody (AChR Ab) might contribute to this complication. ⋯ Although this patient had mediastinal tumor diagnosed as thymic carcinoma two years before the operation, preoperative clinical evaluation was negative for myasthenia gravis (MG) and the tumor was in remission at the operation. These observations suggest that preoperative measurement of anti-AChR Ab level might be recommended for patients with mediastinal tumor regardless of symptoms of MG and that neuromuscular blocking agents should be administrated carefully in anti-AChR Ab positive patients under monitoring of the neuromuscular blockade.
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Intensive perioperative management is required for adrenalectomy in patients with pheocromocytoma because of the unstable hemodynamics and life threatening cardiovascular disturbances due to catecholamine surge from the neuroendocrine tumors. The aim of this study was to assess the perioperative factors contributing to the hemodynamic changes during surgery in pheochromocytoma. ⋯ The decreases of blood pressure after resections of the central veins are dependent on the perioperative blood NA levels, the level of NA in the perioperative urine testig, and tumor sizes.
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Macroglossia is the commonest symptom of Beckwith-Wiedemann syndrome (BWS) and sometimes requires surgical tongue reduction for cosmetic, feeding, drooling and speech problems. ⋯ Airway disorder was not alleviated by tongue reduction surgery or glossopexy.
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It has been demonstrated that preparatory ultrasound scanning can facilitate lumbar epidural anesthesia. We compared longitudinal with transverse approach of ultrasound imaging to test the precision and the quality of acquired images in cesar ean delivery patients. ⋯ Both planes provided accurate information about the epidural space and depth, and the longitudinal plane was superior in the imaging quality. It was suggested that both approaches may help identify epidural spaces.
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A 64-year-old woman was scheduled for the removal of hepatic cystadenoarcinoma. The preoperative examination did not reveal any neurological disorders. Anesthesia was induced with midazolam (5 mg) and remifentanil (0.1.ag x kg-1 x min-1) and the trachea was intubated following administration of rocuronium. ⋯ Two min later, she became fully awake and alert with increase in BIS (above 90). Laboratory examination showed that the plasma concentrations of propofol, midazolam, and its active metabolite alpha-hydroxymidazolam before administration of flumazenil were within the range considered to have no sedative effects. From experience of this case, administration of flumazenil may be beneficial for improvement in consciousness in cases with unexpectedly delayed emergence from anesthesia.