[Desflurane Anesthesia in a Morbidly Obese Patient with Severe Obstructive Sleep Apnea].

A 33-year-old morbidly obese patient (body mass index = 59.5 kg x m(-2)) with severe obstructive sleep apnea was scheduled to undergo osteosynthesis of right radial, ulnar and femoral fractures under general anesthesia. Awake intubation under conscious sedation using fantanyl and midazolam was performed by the Pentax-AWS Airwayscope. By using desflurane under continuous infusion of remifentanil 0.2-0.5 µg x kg(-1) x min(-1), BIS values were maintained between 40 and 60 during the surgery. Although duration of surgery was long (430 minutes), the times from discontinuation of the anesthetic drug to eye opening and extubation were 82 seconds and 8.5 minutes, respectively. Respiratory depression was minimal during postoperative period. In this case desflurane was safely used in a morbidly obese patient with severe obstructive sleep apnea.

[Very late thrombosis of a drug-eluting stent presenting during the operation].

We report a case of very late thrombosis of sirolimus-eluting stent 38 months after implantation of a drug-eluting stent. An 81-year-old woman was suffering from acute cholecystitis and cholelithiasis and laparoscopic cholecystectomy was scheduled. Seven days before the operation, the patient's aspirin was replaced with heparin injection, which was discontinued 4 hours before the operation. During the operation we noticed ST-segment elevation on the monitor. An urgent coronary angiography was performed immediately after the operation, and stent thrombosis was found. Removal of the thrombosis and plain old balloon angioplasty was performed. We should exercise extreme caution for patients undergoing operation after implantation of DES quite a long time ago. We should have concrete guidelines for the treatment of DES patients in the perioperative period.