[Spinal anesthesia for cesarean section in a patient with multiple sclerosis].

Spinal anesthesia is thought to be contraindicated for patients with multiple sclerosis (MS). We describe the case of a patient with MS who was administered spinal anesthesia for cesarean section. A 29-year-old woman (weight 55.8 kg, height 154 cm) with MS underwent an urgent cesarean section in the 39th week of her pregnancy for fetal malpresentation. Although the patient had experienced repeated relapses of MS thrice since she was 19, she had remained in remission since the age of 27, and did not have significant neurological disability. A 27 G needle (pencil type) was used for arachnoid puncture, and 0.5% hyperbaric bupivacaine (2.0 ml) was administered to the subarachnoid space at the L3-4 interspace. After confirming that the sensory blockade after spinal anesthesia had spread to T4, cesarean section was performed. For the subsequent 19 months, no remission of MS was recognized. Thus, spinal anesthesia does not seem to be contraindicated for patients with MS in remission state.

[Remifentanil increases urine output in patients undergoing laparoscopic colectomy].

BACKGROUND: It has been reported that laparoscopic surgery increases stress response such as oliguria. We investigated whether anesthetic methods affect urine output during anesthesia in patients undergoing laparoscopic colectomy. METHODS: Urine output during anesthesia was compared retrospectively between general anesthesia with intravenous infusion of remifentanil, without epidural anesthesia and general anesthesia combined with epidural anesthesia, without remifentanil. Patients were excluded if they had renal failure and/or had received diuretics. 331 American Society of Anesthesiologists (ASA) physical status 1-3 patients who had undergone elective laparoscopic colectomy were enrolled in the study (remifentanil group; n = 214, epidural group; n = 117). In addition, remifentanil group was divided into two groups (higher dose group; n = 108, lower dose group; n = 106) with the median value of 0.3 g x kg(-1) x min(-1). RESULTS: Urine output during anesthesia in remifentanil group was significantly higher than epidural group, although the volume of fluid infusion was significantly less in remifentanil group. Furthermore, urine output in higher dose remifentanil group was significantly higher than the lower dose group, while there were no significant differences in the volume of fluid infusion between the two groups. CONCLUSIONS: Adequate remifentanil injection might increase urine output by preventing stress response to laparoscopic colectomy.

[Anesthetic management for laparoscopic sigmoidectomy in a patient with impaired ventricular function caused by cardiac sarcoidosis].

It has been demonstrated that laparoscopic surgery can reduce surgical trauma and postoperative pain, allowing earlier recovery and hospital discharge. However, because patients with severe cardiac depression may not tolerate the adverse respiratory and cardiovascular effects of pneumoperitoneum with a head-up or head-down tilt position, laparoscopic surgery has been avoided in these patients. The present case with low ventricular function (ejection fraction=23-27%) due to cardiac sarcoidosis could successfully undergo laparoscopic sigmoidectomy by using pulmonary artery catheterization. Therefore, laparoscopic surgery can be performed in patients with cardiac dysfunction if the cardiopulmonary responses caused by pneumoperitoneum with a head-up or head-down tilt are sufficiently considered and adverse hemodynamic responses appropriately detected and treated through invasive monitoring techniques such as pulmonary artery catheterization and/or transesophageal echocardiography.