scholarly journals Anesthetic management for a patient with myotonic dystrophy with remimazolam

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yasuhiro Morimoto ◽  
Aya Yoshimatsu ◽  
Manabu Yoshimura
Keyword(s):  
General Anesthesia ◽  
Myotonic Dystrophy ◽  
Anesthetic Management ◽  
Complete Recovery ◽  
Spontaneous Respiration ◽  
Verbal Command ◽  
Case Presentation ◽  
Intravenous Anesthetic ◽  
Increased Sensitivity ◽  
Recovery From Anesthesia

Abstract Background Patients with myotonic dystrophy may have increased sensitivity to drugs used for anesthesia. We successfully managed general anesthesia in a patient with myotonic dystrophy using a novel intravenous anesthetic, remimazolam. Case presentation The patient was a 46-year-old man, 169 cm in height, and weighing 60 kg. He was diagnosed with myotonic dystrophy 5 years previously. Phacoemulsification for both eyes was scheduled under general anesthesia. Anesthesia was induced with remimazolam 6 mg/kg/h for 1 min and maintained by continuous infusion at 0.25 mg/kg/h during surgery, a 1/4 dose of the standard infusion rate, as indexed by a bispectral index (BIS). Six minutes after remimazolam discontinuation, the patient opened his eyes on verbal command with sufficient spontaneous respiration. Flumazenil (0.2 mg) was administered to boost the patient’s recovery. Conclusion In addition to the short-acting anesthetic remimazolam, the presence of the antagonist flumazenil enabled complete recovery from anesthesia, without postoperative complications.

scholarly journals Intraoperative responses of motor evoked potentials to the novel intravenous anesthetic remimazolam during spine surgery: a report of two cases

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Takashi Kondo ◽  
Yukari Toyota ◽  
Soshi Narasaki ◽  
Tomoyuki Watanabe ◽  
Hirotsugu Miyoshi ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Spine Surgery ◽  
Motor Evoked Potentials ◽  
Optimal Dose ◽  
Fixed Dose ◽  
The Novel ◽  
Organ Function ◽  
Case Presentation ◽  
Intravenous Anesthetic ◽  
Electroencephalogram Eeg

Abstract Background Remimazolam is a novel short-acting benzodiazepine characterized by metabolism independent from organ function. We report intraoperative MEP responses of two patients who underwent spine surgery under general anesthesia using remimazolam. Case presentation In case 1, MEP monitoring was successfully performed with the use of a fixed dose of remimazolam at 0.5 mg/kg/h and remifentanil at 0.2 μg/kg/min. In case 2, an increasing dose of remimazolam from 0.5 to 1.5 mg/kg/h during the operation did not affect MEP signals. In both cases, remimazolam was titrated to maintain the values of entropy electroencephalogram (EEG) monitoring at 40–60. Conclusions General anesthesia using remimazolam and remifentanil can be a valuable alternative for spine surgery with MEP monitoring by EEG to assess the optimal dose.

scholarly journals A Case of Hyperventilation leading to apnea and desaturation in PACU: A root cause analysis

2019 ◽  
Author(s):  
Parineeta Thapa ◽  
Subedi Asish ◽  
Poudel Anjali ◽  
Baral Pankaj
Keyword(s):  
General Anesthesia ◽  
Respiratory Alkalosis ◽  
Early Recovery ◽  
Case Presentation ◽  
Algorithmic Approach ◽  
Root Cause ◽  
Cortical Mastoidectomy ◽  
Recovery From Anesthesia ◽  
Bag And Mask Ventilation ◽  
Possible Cause

Abstract Background Respiratory adverse events are not uncommon in the post anesthesia care unit (PACU) following general anesthesia. In this regard, hyperventilation leading to apnea and desaturation is a rare entity. Here we have reported a case of a 15 year old girl who, following an uneventful general anesthesia, developed severe hyperventilation leading to apnea and desaturation in the PACU. Case presentation The 15 year old girl underwent cortical mastoidectomy under general anesthesia. After a smooth anesthesia and an uneventful early recovery, she developed hyperventilation after about 15 minutes in the PACU. The symptom was severe enough to lead to apnea, desaturation and severe respiratory alkalosis. She required bag and mask ventilation and the symptoms resolved only transiently with propofol sedation. Finally she responded to intravenous haloperidol and did not have any further episode after receiving haloperidol Conclusion Hyperventilation after a smooth recovery from anesthesia is not a common presentation. In this article we have tried to discuss the possible cause of such symptom in our patient and how we successfully managed this case. We have also proposed an algorithmic approach to diagnose and manage such a case in the PACU.

scholarly journals Anesthetic Management Using a Laryngeal Mask Airway in a Child With Congenital Bronchial Atresia

2017 ◽  
Vol 64 (2) ◽  
pp. 102-103
Author(s):  
Yuki Gomi ◽  
Asuka Taguchi ◽  
Sahoko Matsunari ◽  
Taisuke Iwamoto ◽  
Yui Kawamoto ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Oral Surgery ◽  
Anesthetic Management ◽  
Check Valve ◽  
Laryngeal Mask ◽  
Spontaneous Respiration ◽  
Positive Pressure ◽  
Unidirectional Flow ◽  
Rare Malformation ◽  
Bronchial Atresia

Congenital bronchial atresia is a relatively rare malformation that causes a segmental obstruction of the bronchus during the fetal period. The peripheral lung distal from the obstructed bronchus becomes hyperinflated because of the unidirectional flow through collateral check-valve entry. Positive pressure ventilation during general anesthesia may cause a rupture of the bulla, resulting in pneumothorax. An 8-year-old girl, who had to undergo oral surgery, was diagnosed as having congenital bronchial atresia and one-fifth of her lung was poorly ventilated. We planned to perform general anesthesia under spontaneous respiration using a laryngeal mask, which was well tolerated.

scholarly journals A case of hyperventilation leading to apnea and desaturation in PACU

2019 ◽  
Author(s):  
Parineeta Thapa ◽  
Subedi Asish ◽  
Poudel Anjali ◽  
Baral Pankaj
Keyword(s):  
General Anesthesia ◽  
Respiratory Alkalosis ◽  
Post Anesthesia Care Unit ◽  
Early Recovery ◽  
Case Presentation ◽  
Algorithmic Approach ◽  
Cortical Mastoidectomy ◽  
Recovery From Anesthesia ◽  
Bag And Mask Ventilation ◽  
Possible Cause

Abstract Background: Respiratory adverse events are not uncommon in the post-anesthesia care unit (PACU) following general anesthesia. In this regard, hyperventilation leading to apnea and desaturation is a rare entity. Here we have reported a case of a 15-year-old girl who, following an uneventful general anesthesia, developed severe hyperventilation leading to apnea and desaturation in the PACU. Case presentation: The 15-year-old girl underwent cortical mastoidectomy under general anesthesia. After a smooth anesthesia and an uneventful early recovery, she developed hyperventilation after about 15 minutes in the PACU. The symptom was severe enough to lead to apnea, desaturation and severe respiratory alkalosis. She required bag and mask ventilation and the symptoms resolved only transiently with propofol sedation. Finally, she responded to intravenous haloperidol and did not have any further episode after receiving haloperidol. Conclusion: Hyperventilation after a smooth recovery from anesthesia is not a common presentation. In this article we have tried to discuss the possible cause of such symptom in our patient and how we successfully managed this case. We have also proposed an algorithmic approach to diagnose and manage such cases in the PACU.

Women Emerge from General Anesthesia with Propofol/Alfentanil/Nitrous Oxide Faster than Men 

1999 ◽  
Vol 90 (5) ◽  
pp. 1283-1287 ◽  
Author(s):  
Tong J. Gan ◽  
Peter S. Glass ◽  
Jeff Sigl ◽  
Peter Sebel ◽  
Fredrick Payne ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
General Anesthesia ◽  
Bispectral Index ◽  
Anesthetic Management ◽  
Important Variable ◽  
Significant Independent Predictor ◽  
Verbal Command ◽  
Anesthetic Drugs ◽  
Recovery Times ◽  
Eye Opening

Background Recovery from general anesthesia is governed by pharmacodynamic and pharmacokinetic factors. Gender has not previously been recognized as a factor influencing the time to emergence from general anesthesia. Methods This multicenter study was originally designed to measure the effects of the bispectral index on intraoperative anesthetic management and patient recovery. We compared the wake-up and recovery times of 274 adults after propofol/alfentanil/nitrous oxide anesthesia. Patients were randomly assigned to have the titration of propofol performed with or without the use of bispectral index monitoring. Specific guidelines were given for the titration of drugs. The aim in all cases was to provide a safe anesthetic with the fastest possible recovery. Results There was a significant reduction in propofol dose, time to eye opening, and response to verbal command when the anesthetic was titrated using the bispectral index. Unexpectedly, gender proved to be a highly significant independent predictor for recovery time. Women woke significantly faster than men: the time from end of anesthesia to eye opening was 7.05 versus 11.22 min, P < 0.05, and response to verbal command was 8.12 versus 11.67 min, P < 0.05. These differences were significant at all four study sites and in each treatment group. Men consistently had prolonged recovery times compared to women, P < 0.001. There was no difference in the dose of anesthetic used between gender. Conclusions Gender appears to be an important variable in recovery from general anesthesia. These findings may explain the increased reported incidence of awareness in women (three times more frequent) and support the need to include gender as a variable in pharmacokinetic and pharmacodynamic studies of anesthetic drugs.

scholarly journals Esophageal achalasia detected by vomiting during induction of general anesthesia: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kyoko Abe ◽  
Tetsu Kimura ◽  
Yukitoshi Niiyama
Keyword(s):  
General Anesthesia ◽  
Orthopedic Surgery ◽  
Heller Myotomy ◽  
Esophageal Achalasia ◽  
Anesthesia Induction ◽  
Dor Fundoplication ◽  
Case Presentation ◽  
History Of ◽  
Recovery From Anesthesia ◽  
Risk Of Aspiration

Abstract Background Esophageal achalasia is a rare disease with a high risk of aspiration during anesthesia induction. Here, we describe our experience involving a case of undiagnosed esophageal achalasia with profuse vomiting during anesthesia induction. Case presentation A 58-year-old woman was scheduled for orthopedic surgery under general anesthesia. She vomited a large amount of watery contents during anesthesia induction, and planned surgery was postponed. After recovery from anesthesia, she informed us that she usually had to drink a large amount of water to get food into her stomach and purged watery vomit every night before sleep. However, she attributed it to her constitutional problem, not to a specific disease. She was subsequently diagnosed with esophageal achalasia and underwent Heller myotomy with Dor fundoplication before her re-scheduled orthopedic surgery. Conclusions A detailed history of dysphagia and regurgitation should be taken in preoperative examinations to prevent unexpected aspiration due to undiagnosed achalasia.

scholarly journals Perioperative management of a patient undergoing resection of interleukin-6 producing pheochromocytoma

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Masahiro Kuroki ◽  
Hiroto Suzuki ◽  
Misato Kurota ◽  
Masaki Nakane ◽  
Kaneyuki Kawamae
Keyword(s):  
General Anesthesia ◽  
Interleukin 6 ◽  
Perioperative Management ◽  
Anesthetic Management ◽  
Elevated Serum ◽  
Surgical Removal ◽  
Tumor Removal ◽  
Case Presentation ◽  
Postoperative Course ◽  
Inflammatory State

Abstract Background Pheochromocytomas produce hormones, cytokines, and catecholamines. We report perioperative anesthetic management of a rare interleukin-6 (IL-6)-producing pheochromocytoma. Case presentation A 32-year-old female was scheduled for laparoscopic adrenalectomy for pheochromocytoma. She had a sustained high fever with elevated serum noradrenaline and IL-6 levels. The persistent high inflammatory state, followed by anemia, malnutrition, and coagulopathy, led us to prepone her date of surgery. During general anesthesia, alpha-blockers allowed hemodynamic fluctuations to be controlled. During surgery, simultaneous increases in noradrenaline and IL-6 levels were observed, which rapidly declined after tumor removal. Her postoperative course was uneventful, without pulmonary edema caused by cytokine storms. Conclusions The conventional pheochromocytoma strategy allowed surgical removal of an IL-6-producing pheochromocytoma under general anesthesia. However, management of high inflammatory states that induce anemia and coagulopathy is necessary.

scholarly journals A Case of Hyperventilation leading to apnea and desaturation in PACU

2019 ◽  
Author(s):  
Parineeta Thapa ◽  
Subedi Asish ◽  
Poudel Anjali ◽  
Baral Pankaj
Keyword(s):  
General Anesthesia ◽  
Respiratory Alkalosis ◽  
Post Anesthesia Care Unit ◽  
Early Recovery ◽  
Case Presentation ◽  
Algorithmic Approach ◽  
Cortical Mastoidectomy ◽  
Recovery From Anesthesia ◽  
Bag And Mask Ventilation ◽  
Possible Cause

Abstract Background: Respiratory adverse events are not uncommon in the post anesthesia care unit (PACU) following general anesthesia. In this regard, hyperventilation leading to apnea and desaturation is a rare entity. Here we have reported a case of a 15-year-old girl who, following an uneventful general anesthesia, developed severe hyperventilation leading to apnea and desaturation in the PACU. Case presentation: The 15-year-old girl underwent cortical mastoidectomy under general anesthesia. After a smooth anesthesia and an uneventful early recovery, she developed hyperventilation after about 15 minutes in the PACU. The symptom was severe enough to lead to apnea, desaturation and severe respiratory alkalosis. She required bag and mask ventilation and the symptoms resolved only transiently with propofol sedation. Finally she responded to intravenous haloperidol and did not have any further episode after receiving haloperidol Conclusion: Hyperventilation after a smooth recovery from anesthesia is not a common presentation. In this article we have tried to discuss the possible cause of such symptom in our patient and how we successfully managed this case. We have also proposed an algorithmic approach to diagnose and manage such a case in the PACU.

Novel Findings of Anti-cancer Property of Propofol

2018 ◽  
Vol 18 (2) ◽  
pp. 156-165 ◽  
Author(s):  
Jiaqiang Wang ◽  
Chien-shan Cheng ◽  
Yan Lu ◽  
Xiaowei Ding ◽  
Minmin Zhu ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Cancer Progression ◽  
Molecular Mechanisms ◽  
Intravenous Anesthetic ◽  
The Past ◽  
Anti Cancer ◽  
Underlying Mechanisms ◽  
Recent Attention

Background: Propofol, a widely used intravenous anesthetic agent, is traditionally applied for sedation and general anesthesia. Explanation: Recent attention has been drawn to explore the effect and mechanisms of propofol against cancer progression in vitro and in vivo. Specifically, the proliferation-inhibiting and apoptosis-inducing properties of propofol in cancer have been studied. However, the underlying mechanisms remain unclear. Conclusion: This review focused on the findings within the past ten years and aimed to provide a general overview of propofol's malignance-modulating properties and the potential molecular mechanisms.

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