Masui. The Japanese journal of anesthesiology
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Case Reports
[Bilateral recurrent laryngeal nerve paralysis in a child following a neurosurgical operation].
We experienced a case of 7-year-old boy who developed bilateral recurrent laryngeal nerve paralysis following an elective neurosurgical operation under oxygen-nitrous oxide-isoflurane anesthesia. He underwent a removal of brain tumor in the supratentorial region on supine position. After the removal of the endotracheal tube in the intensive care unit, he developed marked respiratory effort and inspiratory stridor. ⋯ In the present case, an endotracheal tube, a transesophageal stethoscope and a nasogastric tube inserted into the narrow laryngeal space might have been a cause of this complication. Moreover, accidental extreme flexion of his neck which occurred during the surgery might also be an additional cause. This case suggests that recurrent laryngeal nerve paralysis due to anesthetic instruments around the larynx is a possible cause of complications during general anesthesia in pediatric patients.
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Comparative Study
[Early postoperative complications in patients with Moyamoya disease--a comparison of inhaled anesthesia with total intravenous anesthesia (TIVA)].
Moyamoya disease is a rare neurovascular disorder that requires special anesthetic managements during revascularization procedures. We have investigated the incidence of early postoperative complications under inhaled anesthesia in comparison with total intravenous anesthesia (TIVA) retrospectively. ⋯ Several previous studies reported the excellence of TIVA for revascularization procedure on the basis of regional blood flow because inhaled anesthesia may provoke intracerebral steal in moyamoya disease. Our investigation in this study revealed that both anesthetic methods have no significant difference in postoperative complications during the first 2 weeks after operation. Thus further study should be needed to verify the safety of inhalation anesthetics in patients with moyamoya disease.
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We report severe hypotension after induction of general anesthesia in a patient receiving an angiotensin II receptor antagonist and an alpha-blocker. A 50-year-old man with diabetes mellitus who had been treated with candesartan cilexetil and doxazosin was scheduled for vitreous surgery. ⋯ Repeated injections of intravenous ephedrine could not raise the blood pressure. After discontinuation of both drugs, although he developed hypotension after induction of anesthesia with propofol and fentanyl, hypotension was mild and responded promptly to intravenous ephedrine.
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Case Reports
[General anesthesia outside the operating room in patients with Pierre-Robin syndrome].
Anesthesiologists are increasingly asked to involve in administering general anesthesia outside the operating room for such procedures as computed tomography, magnetic resonance imaging or angiography. Especially, pediatric patients require some kind of sedation or general anesthesia during these procedures. We report general anesthesia outside the operating room in patients with Pierre-Robin syndrome, who are expected to have possible difficult airway. ⋯ Fortunately, tracheas were successfully intubated without using special devices, although cautious care during induction was taken. According to development of medical and surgical procedures, it is readily presumed that anesthesiologists will be more often involved in the sedation or anesthesia conducted outside the operating room in future. Anesthesiologists should always ensure enough staffing, proper monitoring and equipment when sedation or anesthesia is conducted outside the operating room, particularly if patients have anesthetic risks.
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We experienced four cases of anesthesia for hip fracture reduction in patients with severe heart failure, where anesthesia was attempted with combined paravertebral lumbar plexus and parasacral sciatic nerve block instead of spinal anesthesia. The anesthesia was successful without any sequelae. The patients' characteristics are as follows. ⋯ Eight ml of 0.25% bupivacaine was injected. During the anesthesia, propofol was injected for light sedation. Although this combined nerve block is difficult to perform compared with spinal anesthesia, this could be applicable for hip fracture reduction anesthesia, especially in patients with severe heart failure.