[A Case of Cesarean Section Preceded by Coil Embolization for Subarachnoid Hemorrhage under General Anesthesia].

We report a case of subarachnoid hemorrhage due to rupture of a cerebral aneurysm in a 29-year-old woman in the 34th week of pregnancy. The aneurysm at the anterior communicating artery was up to 10 mm in diameter on magnetic resonance imaging and scheduled for emergent coil embolization. Simultaneously, obstetricians determined that cesarean section should be performed. Maintaining anesthesia by propofol and remifentanil, coil embolization was first performed to avoid aneurism re-rupture, and the patient was then transferred from an angiography room to an operating room where a cesarean section was performed. After delivery, fentanyl 600 µg was intravenously administered, and the patient was extubated immediately after the operation without any complaints. The neonate (weighing 1,882 g, Apgar score 4 at 1 min and 5 at 5 min) also recovered with no complications after 24 hr artificial ventilation. In conclusion, intravenous anesthesia mainly with remifentanil is adequate for a pregnant patient receiving cesarean section preceded by neurosurgery.

[Use of sugammadex in patients undergoing caesarean section using general anesthesia with rocuronium].

Recently, rocuronium is being used in patients for caesarean section undergoing general anesthesia instead of suxamethonium. An increased dose of rocuronium improves intubating conditions but prolongs neuromuscular blockade. Sugammadex reverses rapidly and predictably even profound rocuronium-induced neuromuscular blockade. We experienced 13 cases of caesarean section patients undergoing general anesthesia with thiopental (3.5 mg x kg(-1)) and rocuronium (0.9 mg x kg(-1)). At the end of surgery, sugammadex (2 mg x kg(-1)) was administered every 3 minutes repeatedly until TOF>0.9. In two patients, neuromuscular blockade spontaneously recovered to TOF>0.9 at the end of surgery. In most patients administered sugammadex, TOF recovered to more than 0.9 within a few minutes. However, in one patient who had chronic renal failure (creatinine clearance rate: 12 ml x min(-1)), 10 minutes were required for TOF to recover to more than 0.7, and TOF never reached 0.9. All patients were successfully intubated at the first attempt. No signs of recurarization or adverse effects related to sugammadex were noted in the perioperative period.

Comparative analysis of the properties of bifidobacterial isolates from fecal samples of mother-infant pairs.

OBJECTIVES: The aim of the study was to evaluate the possibility of Bifidobacterium breve transfer from the mother to her infant during the perinatal period. MATERIALS AND METHODS: Hundred isolates of B breve and 80 isolates of Bifidobacterium longum were collected from paired fecal samples of mothers and their infants. Bacterial DNA from the samples was comparatively analyzed by random amplification of polymorphic DNA. The growth of the bacteria was examined in vitro. RESULTS: The analysis of diversity in B breve population showed that infant-derived isolates had significantly less diversity than mother-derived isolates. The analysis of the similarity between these samples revealed that the number of shared type isolates tended to be higher in infants than in their mothers. In the isolates of B longum, however, no such difference was found in the diversity between mother- and infant-derived isolates. Examination of the growth of B breve strains revealed that the shared type strains have a significantly higher growth than nonshared strains both in the presence of galactooligosaccharides and at a higher redox potential. CONCLUSIONS: These results suggested that subpopulations of B breve strains in the mothers may be transferred to their infants. Such populations may become dominant in the gut of infants at an early time after birth, during which time the transmission of the bifidobacteria of environmental origin is not yet established. B breve strain possessing a higher growth advantage in these conditions may be advantageous for colonization in the infant gut.