Masui. The Japanese journal of anesthesiology
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Case Reports
[General anesthesia in a patient with Cornelia de Lange syndrome with restricted opening of the mouth].
Patients with Cornelia de Lange syndrome have many anomalies including micrognathia with a small mouth, a high arched palate, and a short neck, which might make laryngoscopy for tracheal intubation difficult during induction of general anesthesia. General anesthesia was performed in a patient with Cornelia de Lange syndrome, and restricted opening of the mouth, which had not been reported previously, was found during laryngoscopy. The possible causes were thought to be temporo-mandibular joint disorders, contracture of the masseter muscle due to injury by self-destructive tendencies, or elogated coronoid process. The potential difficulty with laryngoscopy should be considered for tracheal intubation in a patient with Cornelia de Lange syndrome.
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Case Reports
[Urgent cesarean section under combined spinal and epidural anesthesia in a patient with aortitis syndrome].
We report the anesthetic management of a patient with aortitis syndrome using combined spinal and epidural anesthesia. A 28-year-old gravida with aortitis syndrome accompanied by faints was scheduled for an urgent cesarean section. Combined spinal and epidural anesthesia was thought to be better for this case in order to monitor the cerebral circulation by her consciousness level and to reduce the hemodynamic change during surgery as compared to spinal or epidural anesthesia alone. ⋯ The level of analgesia reached to Th 6 without major hemodynamic changes. A healthy 2740 g infant was delivered and she had an uneventful recovery. We conclude that combined spinal and epidural anesthesia is useful in a patient with aortitis syndrome undergoing an urgent cesarean section in order to monitor the cerebral circulation by the consciousness level and to reduce the hemodynamic change.
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Case Reports
[Bronchodilator aerosol propellant interferes with an photoacoustic spectrophotometer respiratory gas analyzer].
A patient with bronchial asthma was scheduled for an operation under nitrous oxide-isoflurane anesthesia. We monitored isoflurane concentrations continuously using an anesthetic gas analyzer (BK 1304). ⋯ The BK 1304 uses infrared photoacoustic spectrophotometry and it is susceptible to interferences caused by Freon propellants in bronchodilator aerosols. We should take care in monitoring inhalational anesthetics when using aerosols containing Freon propellants.
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We investigated the efficacy and untoward effects of low doses of propofol for intrathecal morphine-induced pruritus. Twenty gynecological and obstetric surgical patients received spinal anesthesia with 0.5% tetracaine and phenylephrine, as well as 0.2 mg morphine. Seven of them (35%) complained pruritus graded according to the treatment necessary in the postoperative period. ⋯ One patient was resistant to treatments by 20 mg of propofol and 0.1 mg of naloxone. Three patients transiently fell in sleep even after administering 10 mg of propofol. The authors conclude that low dose propofol is effective in treating intrathecal morphine-induced pruritus, although it may transiently causes hypnosis in postoperative patients.
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We examined 171 patients who had undergone anterior cervical fusion to determine the frequency and the causes of postoperative respiratory disturbance (PRD). Postoperative tracheal intubation was necessary in 11 patients (6.4%), but only 4 of them (2.3%) required reintubation due to PRD caused by surgical procedures. ⋯ As C 3 was fused in the 4 patients with PRD, requiring reintubation, upper airway obstruction due to serious swelling of the soft tissue surrounding C 3 might be the factor leading to postoperative reintubation. One of the PRD patients who suffered from postoperative unilateral phrenic nerve palsy required controlled ventilation.