[Case of myotonic dystrophy eventually diagnosed by preoperative Allen's test].

A 59-year-old woman was scheduled for resection of a parotid tumor under general anesthesia. Preoperative interview was done 7 days before the operation. Laboratory data were normal except for a slightly elevated CPK level. Though ECG showed abnormal P and T waves, exercise ECG was normal. Respiratory function test revealed decreased %VC. She did not complain of motor weakness and atrophy of distal muscles. When the anesthesiologist did Allen's test, slow relaxation of hand grip, i.e. grip myotonia, was observed. Further history taking disclosed that she had a family history of myotonic dystrophy (MD) in her son. She was diagnosed as MD by a neurologist on the day of preoperative interview, although she lacked obvious symptoms and consciousness of MD. The operation was performed as scheduled and she was anesthetized with oxygen-nitorous oxide, propofol, fentanyl and vecuronium. Vecuronium was not antagonized because of the adverse effect of neostigmine reported in MD patients. The operation and anesthesia were conducted uneventfully. Her recovery from anesthesia was so smooth that she was discharged uneventfully. In this case, careful examination led to diagnosis of MD and prevented perioperative complications associated with MD. It is important to examine patients meticulously not to miss trivial symptoms in our daily visits.

[Prophylactic effects of neutrophil elastase inhibitor for patients undergoing surgery for thoracic aortic aneurysm: a retrospective study].

BACKGROUND: Systemic inflammatory response syndrome (SIRS) can occur after cardiac surgery under cardiopulmonary bypass (CPB), especially thoracic aortic surgery. Several reports have suggested that the earlier neutrophil elastase inhibitor (NEI) is used, the more dramatically the acute lung injury (ALI) following SIRS can be improved. We therefore examined whether prophylactic administration of NEI is effective in treating ALI following SIRS. METHODS: In a retrospective study, 24 patients were divided into a control group and a NEI group, for whom infusion of NEI 0.2 mg x kg(-1) x hr(-1) was started prior to initiation of CPB. We compared PaO2/FIO2 (P/F) ratio, intubation time, ICU stay, and numbers of intubated patients and patients admitted to the ICU between the two groups. We also examined laboratory findings for the two groups related to systemic inflammation and organ function. RESULTS: In the NEI group, P/F ratio tended not to be exacerbated postoperatively, which might have been responsible in part for the finding that intubation time and ICU stay were significantly shorter and ratios of intubated patients and those staying in the ICU were significantly lower in the NEI group. Laboratory findings in the two groups fluctuated similarly. CONCLUSIONS: Prophylactic administration of NEI appears to be useful for achieving early extubation and discharge from the ICU of patients undergoing thoracic aortic surgery.

An effective use of magnesium sulfate for intraoperative management of laparoscopic adrenalectomy for pheochromocytoma in a pediatric patient.

IMPLICATIONS: This report concerns a case for which the intraoperative use of magnesium sulfate as an adjunct to the conventional use of nicardipine was effective for managing a pediatric patient with pheochromocytoma who was undergoing a laparoscopic operation.