Masui. The Japanese journal of anesthesiology
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A 68-year-old man was scheduled for pancreaticoduodenectomy under general anesthesia. He was suffering from Charcot-Marie-Tooth disease (CMTD) for 34 years, and complicated with liver cirrhosis. Anesthesia was induced with propofol and fentanyl, and maintained with oxygen-air-sevoflurane and remifentanil. ⋯ Rocuronium was injected intravenously for tracheal intubation, supplemented as required using an electrical nerve stimulator. The longer duration of action of rocuronium was observed in this case because the patient was complicated with CMTD and liver cirrhosis. We suggest that monitoring neuromuscular function may be necessary to detect subtle residual neuromuscular blockade when rocuronium is used in a patient with CMTD and liver dysfunction.
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Propofol target-controlled infusion (TCI) is now commonly used for induction and maintenance of anesthesia. In this study, we measured the propofol plasma concentrations in obese patients in order to test our hypothesis that propofol TCI is reliable for use in obese patients. ⋯ We conclude that propofol TCI is a reliable method for maintaining anesthesia even in obese patients. At emergence, however, the data suggested that the plasma concentrations might be lower than the estimated values in obese patients.
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Case Reports
[Case of inguinal hernia repair with transversus abdominis plane block and rectus sheath block].
Transversus abdominis plane block is effective for lower abdominal and inguinal operations, and rectus sheath block is effective for abdominal operations. Recently, ultrasound guided nerve block has been employed, and these techniques can be performed with ultrasound scanning. ⋯ We did not want to select general anesthesia for him, and performed rectus sheath block and transversus abdominis plane block. We achieved good anesthetic management using two peripheral blocks under ultrasound scanning.
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In adult patients, there is a strong correlation between the appropriate depth of insertion of a left double-lumen endobronchial tube (DLT) and height. However, for patients with the same height, we noted the tendency of the depth of insertion being about 1 cm shorter for patients under 19 years of age compared to that for those over 20 years. ⋯ During intubation of the bronchi with DLT in patients under 19 years, the optimal depth of DLT insertion is less than that for patients over 20 years.
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Case Reports
[Difficult tracheal intubation using airway scope in a pediatric patient with Hunter syndrome].
Hunter syndrome, manifested by mucopolysaccharidosis II (MPS II), is a hereditary disorder caused by accumulation of glycosaminoglycans. An important issue in regard to anesthesia in affected individuals is airway management, because of gargoylism. An 8-year-old boy with MPS II was scheduled for adenotonsillectomy. ⋯ Finally, we inserted a stylet into the tracheal tube attached to the blade of the AWS and successful tracheal intubation was accomplished. The operation was completed uneventfully and the patient entered the ICU with his trachea intubated, because of pharyngeal and laryngeal edema. Although useful for difficult airway management, tracheal intubation with the AWS may be difficult when used in patients with a narrow oral cavity or small tracheal tube.