Masui. The Japanese journal of anesthesiology
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Case Reports
[Anesthetic management of a patient with mitochondrial encephalomyopathy for renal transplantation].
A 52-year-old man with mitochondorial encephalomyopathy was scheduled for renal transplantation from a living donor. He had some characteristic features including muscle weakness, deafness, cerebellar ataxia, diabetes meritus and renal failure. Anesthesia was induced with bolus infusion of propofol 1 mg x kg(-1) and continuous infusion of remifentanil at 0.15 microg x kg(-1) x min(-1) was started. ⋯ After administration of naloxone 40 microg to antagonize the action of remifentanil, the patient recovered fully from the respiratory depression. The urine output was depressed initially after implantation of donor's kidney, but gradually increased to a usual recovery pattern. This case suggests that careful administration of remifentanil is mandatory in a patient with mitochondorial encephalomyopathy which enhances respiratory depression from opioids.
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Arrhythmia during general anesthesia occurrs occasionally as a result of the effect of inhalation anesthetic agent on cardiac conduction. We experienced a case of atrioventricular junctional rhythm (AVJR) during maintenance of general anesthesia with sevoflurane. A 61-year-old woman with normal preoperative electrocardiogram was scheduled for right total knee arthroplasty and autologous iliac crest bone graft under general and epidural anesthesia. ⋯ After discontinuation of sevoflurane at the end of the operation, isorhythmic dissociation returned to sinus rhythm. Sevoflurane could induce atrioventricular conduction disturbance leading to isorhythmic dissociation of AVJR. We should be aware that hypotension can result from isorhythmic dissociation during sevoflurane anesthesia.
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A 36-year-old woman was scheduled for the right lower lobe resection under the left one-lung ventilation with a double-lumen tube (DLT). Difficult intubation due to limited (1.5 cm) mouth opening was recognized following the induction of anesthesia. ⋯ Ventilation was well maintained using the nasal mask, and the gas leakage was coped with tightening the lips with the tube and using a high flow of oxygen. This nasal mask ventilation method is useful and safe in cases of difficult intubation by DLT in which no other proper methods are available.
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Case Reports
[Total intravenous anesthesia with propofol and remifentanil for a patient with myotonic dystrophy].
A 54-year-old woman, complicated with myotonic dystrophy, underwent laparoscopic cholecystectomy for cholelithiasis. The patient was given total intravenous anesthesia using propofol, remifentanil and vecuronium, combined with epidural anesthesia using ropivacaine. ⋯ The postoperative course was uneventful. The anesthesia with remifentanil is extremely useful for patients with myotonic dystrophy.
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We described our management of a patient with moyamoya disease who presented for emergency cesarean section. A 29-year-old primigravida (162 cm, 61 kg) who had been diagnosed as having moyamoya disease at age 24, underwent urgent cesarean section at 35 weeks of gestation. Because she was medicated with aspirin, general anesthesia was selected. ⋯ The cesarean delivery was uneventful and a healthy 2104 g neonate was delivered with Apgar score of 7 and 9 at 1 and 5 min, respectively. Landiolol was effective for treating intraoperative hypertension and tachycardia. Monitoring of depth of anesthesia, blood pressure, and ventilation would be essential for cesarean section under general anesthesia in patients with moyamoya disease.