RESUMEN
In this case report, we describe separate instances of general anesthetic management administered to a patient during treatment for two unrelated conditions. The patient, a 57-year-old woman who had been experiencing walking difficulties for about four years, fell down because of muscle rigidity and spasms and fractured her humerus. She was subsequently diagnosed with stiff-person syndrome. The fracture was treated conservatively, but three weeks later the alignment of the humerus became worse and the patient was scheduled to undergo an open reduction and internal fixation under general anesthesia (GA). Anesthesia was induced using propofol and fentanyl, and rocuronium was given for the tracheal intubation. The operation was completed successfully while anesthesia was maintained using sevoflurane and remifentanil without incident Four months later, the patient developed paraneoplastic syndrome stemming from breast cancer, and underwent a resection of the cancer under GA. The patient received propofol for the laryngeal mask insertion, and sevoflurane and pentazocine for maintenance of anesthesia. She was discharged from the hospital without any respiratory or airway problems. We used sevoflurane for maintenance of anesthesia on both occasions, and rocuronium for the first tracheal intubation. The patient's hemodynamics were stable during the operation. No prolonged effect of the muscle relaxant or any autonomic reactions were observed. The patient was fully conscious and in good respiratory condition after both surgeries, and was extubated in the operating room. There were no perioperative complications.
Asunto(s)
Anestesia General/métodos , Síndrome de la Persona Rígida/cirugía , Combinación de Medicamentos , Femenino , Humanos , Persona de Mediana Edad , CaminataRESUMEN
A 32-year old man with Sturge-Weber syndrome, a rare congenital disease of multiple angiomatous lesions including cervical cortex, face, oral soft tissues, larynx and trachea, underwent the excision of a back lipoma. His hemangioma which extended into the region of the right ophthalmic nerve and superior maxillary nerve is extremely large. He also had mental retardation and epilepsy. No apparent hemangioma was found in his oral cavity, pharynxes, larynx and trachea by preoperative exam. His hemangioma made it difficult to cover his mouth and nose by usual face mask. Though we first considered awake intubation, he was difficult to obey our command. So we searched for the face mask covering his nose and mouth without pressing his facial angioma. Finally, we discovered the full-face mask for NIPPV. After induction with propofol, we confirmed the perfect mask fit, and ventilation by two-person method was effective. Then we administered rocuronium and fentanyl, and intubated without difficulty. The patient was maintained by sevoflurane. He was hemodynamically stable. He was extubated without bleeding and respiratory problems. We experienced general anesthesia of a patient with Sturge-Weber syndrome who had a giant facial hemangioma. With full-face NIPPV mask we safely induced general anesthesia.
Asunto(s)
Anestesia General , Hemangioma/complicaciones , Hemangioma/cirugía , Intubación Intratraqueal/métodos , Lipoma/cirugía , Neoplasias Cutáneas/cirugía , Síndrome de Sturge-Weber/complicaciones , Síndrome de Sturge-Weber/cirugía , Adulto , Dorso , Cara , Humanos , Intubación Intratraqueal/instrumentación , Máscaras Laríngeas , Laringoscopios , Lipoma/complicaciones , Masculino , Atención Perioperativa , Neoplasias Cutáneas/complicacionesRESUMEN
BACKGROUND: Electroconvulsive therapy (ECT) is performed under general anesthesia (GA). GA could reduce the vigorous hemodynamic response including hypertension and tachycardia during ECT. This may be beneficial in patients with cardiovascular diseases. On the other hand, however, many intravenous and inhalational anesthetic agents potentially suppress the seizure and shorten the duration. The aim of this study is to elucidate whether propofol is superior to sevoflurane in maintaining the duration of electroencephalographic (EEG) seizure evoked by Thymatron System while stabilizing hemodynamic responses. METHODS: Thirteen patients (male:female = 3:10) were included in this cross-over study. The patients underwent 54 ECT sessions in total. The sessions were randomized into two groups. In the propofol group (P group), the patients received intravenous propofol 1 mg x kg(-1) on induction of anesthesia, whereas those in the sevoflurane group (S group) were induced with sevoflurane at 5% inspired concentration. In either group, after loss of consciousness, the patients received 1 mg x kg(-1) of suxamethonium. When muscle fasciculation faded away, the electrostimulus was delivered. The duration of EEG seizure, heart rate (HR) and noninvasive mean arterial blood pressure (MAP) were recorded. RESULTS: The duration of EEG seizure was longer in P group (34.6 +/- 15.5 sec versus 23.6 +/- 12.0 sec in S group, P = 0.006). There was no significant difference in hemodynamic parameters (MAP, HR) between the two groups. CONCLUSIONS: The duration of EEG seizure in ECT was significantly longer with propofol anesthesia than sevoflurane anesthesia. Propofol may provide more benefits than sevoflurane as the anesthetic for ECT.
Asunto(s)
Anestesia por Inhalación , Anestesia Intravenosa , Terapia Electroconvulsiva , Éteres Metílicos , Propofol , Adulto , Anciano , Anciano de 80 o más Años , Electroencefalografía , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , SevofluranoRESUMEN
The number of the patients with psychiatric disease is increasing. Ministry of Health, Labour and Welfare eventually added psychiatric disease to the conventional four major disorders making it fifth biggest illness in July, 2011. Since mECT is assuming a important role in the treatment of various psychiatric diseases, we have more cases in which anesthesia management is required. Anesthesiologists must collaborate with psychiatrists to perform safe ECT and understand indication, procedure and how to use the treatment device for ECT.
Asunto(s)
Anestesiología , Terapia Electroconvulsiva/métodos , Grupo de Atención al Paciente , Psiquiatría , Humanos , Trastornos Mentales/terapiaRESUMEN
Myasthenia gravis (MG) is considered to be an autoimmune disorder of neuromuscular transmission and is rare in childhood. We report 3 juvenile MG (JMG) cases of extended thymectomy (ETMX) combined postoperative high-dose steroid therapy. All patients developed MG symptoms under the age of 14 years and were given cholinergic drugs and had generalized MG: the Myasthenia Gravis Foundation of America classification II was present in 1 case and classification III was in 2. All patients were taking pyridostigmine before surgery; none was treated with prednisone preoperatively. All patients performed the ETMX combined postoperative high-dose steroid therapy. Muscle weakness of extremities and bulbar symptoms improved in all patients, but not all exhibited an unstable phase in their clinical course as a result of combined therapy. There was no postoperative morbidity or mortality. All patients had follicular lymphoid hyperplasia without thymoma. Follow-up for more than 5 years has shown one to be in complete remission and the others to have improved symptoms. Although our results are inconclusive because we used only a few JMG patients, the ETMX combined postoperative high-dose steroid therapy appeared to provide a better chance of remission or control of symptoms.
Asunto(s)
Glucocorticoides/administración & dosificación , Miastenia Gravis/tratamiento farmacológico , Miastenia Gravis/cirugía , Prednisona/administración & dosificación , Timectomía , Adolescente , Niño , Inhibidores de la Colinesterasa/administración & dosificación , Terapia Combinada , Humanos , Masculino , Bromuro de Piridostigmina/administración & dosificación , Resultado del TratamientoRESUMEN
We report a case of an 8-year-old boy with laryngeal edema and vocal cord paralysis due to lithium battery ingestion. He had ingested a lithium battery of a television remote controller, and was admitted to our hospital. He was suffering from wheezing and retractive respiration with crying. The foreign body was removed under general anesthesia about two hours after the ingestion. It was a 3 volt lithium battery of 20 millimeters in diameter. Endoscopy showed chemical burn of the postcricoid area and severe edema of the laryngeal arytenoids. Twelve days later we confirmed healing of edema and extubated the tracheal tube, but endoscopy showed bilateral vocal fold paralysis. He had no difficulty in breathing and eating but the vocal cord paralysis remained. Lithium batteries ingestion may cause severe airway injury in a short period because of their large size and high voltage. Immediate removal and careful management are required.