Masui. The Japanese journal of anesthesiology
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There are several specific considerations regarding seizure control during the perioperative period in patients who are on a ketogenic diet (KD). A KD is high in fat and low in protein and carbohydrates and has a long history of use for treatment of intractable seizures in children. ⋯ We report a case in which a 3-year-old boy with seizure was on a KD and scheduled for the treatment of left undescended testis under propofol anesthesia and acetate Ringer administration. Induction and maintaining of anesthesia using propofol was safe and reasonable for a patient on a KD.
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We described a case of ventricular fibrillation in patients with Brugada type electrocardiogram (ECG) during surgery. A 63-year-old man underwent lung lobectomy under combined general and epidural anesthesia. His preoperative ECG showed Brugada type, but he was asymptomatic and did not have a family history of sudden death. ⋯ Previous report describes that the incidence of vasospasm in Brugada type ECG cases is relatively higher than those with the normal ECG. In addition, ventricular fibrillation might be induced by local anesthetics because these agents were administrated 10 minutes before the few events and balance of autonomic nervous system was changed. We conclude that strict monitoring and immediate treatment for ventricular fibrillation are important for anesthetic management in asymptomatic patient with Brugada type ECG.
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A forty-year old man hanged himself and was transported to our hospital. On arrival his consciousness was clear but he showed dyspnea, dysphagia, and oral bleeding. Tracheal intubation was attempted but was failed and emergency tracheostomy was successfully accomplished. ⋯ Orotracheal intubation was accomplished with StyletScope. It worked very well for the destroyed trachea. StyletScope is a useful device for intubation, especially in difficult airway management.
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Postoperative nausea and vomiting (PONV) are the most frequent side effects after anesthesia. Patients with persistent PONV continue to be impaired in performing their normal daily activities. We studied the controlling effect of dexamethasone (4 mg) before the induction of general anesthesia in the prevention of PONV. ⋯ Combination therapy with dexamethasone and droperidol may reduce PONV in patients undergoing surgery.
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The i-gel, which has been introduced into clinical practice in Japan in 2010, has a potential role in maintaining a clear airway during general anesthesia. ⋯ We believe that the i-gel is useful in maintaining a clear airway during general anesthesia.