[General Anesthesia with Remifentanil for Cesarean Section in a Patient with Moyamoya Disease].

A 31-year-old primigravida diagnosed with moyamo- ya disease at age 27, underwent an urgent cesarean section at 37 weeks of gestation. At age 27 the patient had a superficial temporal artery-middle cerebral artery bypass operation, but the blood flow was not enough. Because she had serious anxiety neurosis and could not endure the strain of vaginal delivery or spi- nal anesthesia, general anesthesia was selected. Anesthesia was induced with thiopental, remifentanil and rocuronium, and was maintained with sevoflurane in air oxygen mixture before delivery. After delivery, anesthesia was maintained with propofol and remifent- anil. Hypertension caused by tracheal intubation was successfully prevented by remifentanil. The cesarean delivery was uneventful and a neonate was delivered with Apgar scores of 3 and 9 at 1 and 5 min, respec- tively. No adverse symptoms occurred. Both she and the neonate were discharged without adverse events. Remifentanil was effective for treating perioperative hypertension undergoing caesarean delivery in a patient with moyamoya disease.

[A Successful Case of Recovery from the Amniotic Fluid Embolism with Cardiac Arrest during the Operation].

Amniotic fluid embolism (AFE) is a disorder with a high mortality rate. We present a case of AFE with cardiac arrest during the cesarean section who recovered sequela. A 28-year-old woman was diagnosed as low lying placenta and planned to undergo cesarean section in 38th gestational week. She had atypical genital bleeding in 32nd gestational weeks and she received emergency cesarean section under general anesthesia. After expulsion of her fetus, she lost many blood. We suspected obstetric DIC and started therapy immediately, but cardiac arrest occurred suddenly. She was resuscitated, and we decided to suspend the operation with temporary gauze-packing. After in better general condition, we removed the packed gauze from her abdomen. She could leave the intensive care unit 7 days after the first operation. In this case, the crucial points for successful resuscitation were prompt obstetric anesthesiologist involvement and good communication with obstetricians.

[A Biphasic Anaphylactic Attack from Sugammadex with a Severe Second Attack].

A 74-year-old man was scheduled for transurethral resection of the prostate under general anesthesia. Anesthesia was induced by propofol, rocuronium, remifentanil and maintained with sevoflurane. The operation was finished in 56 minutes without trouble. After operation, sugammadex was administered, and after about 2 minutes, redness, tachycardia, hypotension and itchiness appeared. Treatment was initiated using steroids, adrenaline, and antihistamine upon diagnosis of anaphylaxis caused by sugammadex. Reaction to the treatment was good and the general condition improved to normal; however, the patient was moved to the intensive care unit for follow-up observation. Furthermore, no upper respiratory tract symptoms were observed during the follow-up along with no decline in SpO2. The condition progressed without any particularly major abnormalities after entering the intensive care unit; however, a sudden decline in blood pressure and dyspnea occurred again 3 hours following entering the intensive care unit. These were considered to be biphasic reactions due to anaphylaxis, and treatment was carried out again with intravenous injection of adrenaline, steroids and inhalation of beta-agonist. No symptoms were observed since and the patient was discharged from the intensive care unit the following day.