Usefulness of bilateral cerebral regional oxygen saturation measurements in determining selective cerebral perfusion flow rate in a pediatric patient with aortic arch stenosis: a case report.

BACKGROUND: We report a pediatric case where bilateral regional oxygen saturation (rSO2) measurements were useful in determining the selective cerebral perfusion (SCP) flow rate. CASE PRESENTATION: A 9-year-old Japanese boy, 128 cm tall and weighing 25.6 kg, was scheduled for aortic arch reconstruction due to a 90-100 mmHg pressure gradient. Pediatric-sized oximetry sensors were attached to the bilateral forehead area. The rSO2 levels were 70-80% on the right and 80-90% on the left during cardiopulmonary bypass. Immediately following deep hypothermic circulatory arrest with the body temperature cooled to 25 °C, SCP was initiated from the right brachiocephalic artery at 10 mL/kg/min. As the rSO2 decreased steeply to 43-45% on the right and to 32-38% on the left, the SCP flow was increased to 15 mL/kg/min. The right rSO2 increased promptly to 50-60%, but the left rSO2 remained at 30-40%. After the SCP flow was increased to 20 mL/kg/min, bilateral rSO2 levels of 50-60% were obtained, and the SCP flow rate was maintained. The patient was transferred to the ICU postoperatively and extubated on the second postoperative day with no neurological abnormalities. CONCLUSIONS: Bilateral rSO2 measurements are essential even for a pediatric patient undergoing SCP, despite the limited forehead area.

Remimazolam and Remifentanil Anesthetics for an Adolescent Patient with Stiff-Person Syndrome: A Case Report.

Stiff-person syndrome (SPS) is a rare autoimmune disease characterized by fluctuating rigidity and stiffness of the axial muscles. There are no reports on the use of remimazolam in a patient with SPS. A 16-year-old Japanese woman with SPS was scheduled to undergo intrathecal baclofen pump exchange. General anesthesia was induced and maintained using remimazolam, remifentanil, and intermittent rocuronium bromide. No intraoperative mobility or significant autonomic symptoms were observed. Additionally, electroencephalographic signature showed sufficient anesthetic depth. The patient's emergence from general anesthesia was uneventful. In conclusion, remimazolam could be considered an effective anesthetic drug for patients with SPS.

A Remimazolam and Remifentanil Anesthetic for a Pediatric Patient With a Medium-Chain Acyl-CoA Dehydrogenase Deficiency: A Case Report.

Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency is one of the most common fatty acid oxidation disorders. The choice of anesthetics and blood glucose management are crucial to prevent metabolic decompensation. A 5-year-old Japanese boy with MCAD deficiency was scheduled to undergo surgery for an inguinal hernia. Glucose was continuously infused perioperatively, and his glucose concentrations were within the normal range. Anesthesia was induced and maintained with remimazolam, remifentanil, and intermittent rocuronium. No metabolic decompensation was observed. This case indicates the importance of a continuous intravenous glucose infusion, and that remimazolam can be the first-line anesthetic for a patient with MCAD deficiency.