[Anesthetic management of extracorporeal shock wave lithotripsy: case reports of four young patients with epilepsy].

Four young patients, including a 7-year-old girl with Aicardi syndrome, an 11-year-old boy with Lennox-Gastaut syndrome, a 22-year-old man with epilepsy due to childhood encephalitis, and a 17-year-old girl with Rett syndrome, were scheduled to undergo extracorporeal shock wave lithotripsy (ESWL) for urolithiasis. Epilepsy in all of the patients was well controlled by medication. Series of ESWL treatment were safely performed under general anesthesia with tracheal intubation. We recommend that maintenance of anesthesia be performed by sevoflurane and nitrous oxide, which can increase threshold of epileptic stroke, and controlled ventilation with a muscle relaxant should be performed to prevent lung or renal injury by the shock wave of ESWL.

[Effect of landiolol hydrochloride for intraoperative tachycardia--multicenter questionnaire study].

BACKGROUND: The purpose of this study was to evaluate effects of landiolol hydrochloride, which is an ultra-short-acting beta-1 selective blocker, for intraoperative tachycardia and to establish practical methods of administration of the drug. METHODS: We retrospectively examined by multicenter questionnaires the effects and practical methods of administration of landiolol for 100 patients who showed tachycardia needing treatment during anesthesia. The techniques for anesthesia and administration of landiolol were entrusted to each anesthesiologist. RESULTS: One case was excluded because the dose of landiolol hydrochloride was uncertain. Fifty-nine patients received an intravenous bolus injection of landiolol, and continuous injection was performed in 34 patients. Six patients had both bolus and continuous injections. In the 99 patients, heart rate was significantly reduced to desired levels. The time required to reduce heart rate by more than 10% after injection was shorter in the bolus group than in the continuous group. Bolus injection, however, did not reduce blood pressure. Although low-dose continuous administration significantly reduced blood pressure, treatment for increasing blood pressure was not needed in any of the patients. CONCLUSIONS: Information obtained by the questionnaire suggests that bolus injection and/or low-dose continuous administration of landiolol, which are not described in the drug information documents, are effective and safe for treatment of tachycardia during anesthesia.