Masui. The Japanese journal of anesthesiology
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A 40-year-old man was scheduled for video assisted thoracoscopic surgery due to pneumothorax. He had been diagnosed with inclusion body myositis and received nocturnal non-invasive positive pressure ventilation. Anesthesia was induced with propofol, remifentanil, and rocuronium, and maintained with propofol, remifentanil and fentanyl. ⋯ Rocuronium 10 mg was administered in this case and we thought it could be antagonized by neostigmine, but extubation on the day of operation was impossible. We think this is not because of the residual effect of muscle relaxant, but because of decreases in pulmonary function. In this case, we expected long-term mechanical ventilation might be necessary, but he showed a good postoperative course owing to minimally invasive surgery, NPPV, and suctioning of sputum via Minitrach.
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[Effect of interscalene block on perioperative pain during arthroscopic rotator cuff repair (ARCR)].
There are some reports stating that interscalene block is effective in relieving perioperative pain during arthroscopic rotator cuff repair (ARCR), and we used this procedure for ARCR in our department since May 2011. ⋯ Single-shot interscalene block before ARCR reduced both blood pressure variability and the dose of fentanyl given during operation.
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A 78-year-old woman with low pulmonary function (forced expiratory volume in 1 second of 450 ml) underwent an open incisional pulmonary tissue biopsy for suspected diffuse panbronchiolitis and anti-neutrophil cytoplasmic antibody-associated vasculitis. She was intubated with a double-lumen tracheal tube after receiving 0.57 mg x kg(-1) of rocuronium and 0.9 mg kg(-1) of propofol. Under one-lung ventilation, the PaCO2 was 54-74 mmHg and PaO2 was 121-127 mmHg until 50 min after lung recruitment, after which the PaCO2 decreased to 62-66 mmHg and PaO2 increased to 283-382 mmHg. ⋯ Although the rocuronium-induced neuromuscular blockade was reversed by 2.0 mg x kg(-1) of sugammadex (train-of-four ratio, nearly 100%), it seemed a little difficult to extubate the patient just after the operation because blood gas analysis showed a pH 7.39, PaCO2 of 66 mmHg and PaO2 382 mmHg with FIO2 1.0. The blood gas analysis revealed pH 7.52, PaCO2 44.5 mmH and PaO2 144 mmHg with FIO2 of 0.4. The patient was successfully extubated with no respiratory complication 10 h after the end of the operation on the first postoperative day.
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Case Reports
[Insufficient sugammadex effect in an obese pregnant woman undergoing cesarean section under general anesthesia].
A 32-year-old pregnant woman (height 162 cm, weight 86 kg, age of fetus 25 weeks) without preoperative complications underwent an emergent cesarean section under general anesthesia. She was intubated with a 7.0-mm tracheal tube 40 s after receiving rocuronium 0.93 mg x kg(-1) and thiamilal 375 mg. Anesthesia was maintained with oxygen, air, sevoflurane 1.0-2.5%, and fentanyl 425 microg. ⋯ Fifteen minutes after sugammadex administration (train-of-four ratio 14%), she received atropine 0.5 mg and neostigmine 1.0 mg. Ten minutes later, the train-of-four ratio increased to 89%, and the patient was successfully extubated with no respiratory suppression. We speculate that the rocuronium dose (0.93 mg x kg(-1)) was too high in this obese patient, and sugammadex dose at the end of the surgery was not enough for reversal of rocuronium-induced neuromuscular blockade.
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Case Reports
[Acoustic respiratory rate monitoring in a patient with a tracheostomy: a case report].
Acoustic respiratory rate (RRa) monitoring has been validated for patients after general anesthesia and has been shown to be a useful technique. However, its feasibility in patients with a tracheostomy has not been assessed yet. Successful monitoring of RRa in a patient with a tracheostomy is described in this case report. ⋯ Statistical analysis was made for comparison of respiratory rate determined by RRa monitoring with respiratory rate visually counted by intensive care nurses. There was no statistically significant difference between the two respiratory rates (P = 0.82). RRa monitoring is useful even in patients with a tracheostomy.