[Influence of intraoperative fentanyl and remifentanil infusion on early postoperative oral intake after general anesthesia].

BACKGROUND: There is no reports on influence of intraoperative fentanyl and remifentanil infusion on ability of oral intake after short stay surgery under general anesthesia. METHODS: Data were collected retrospectively on 497 patients undergoing short stay surgery under general anesthesia with intraoperative remifentanil infusion (R group, n = 273) or without intraoperative remifentanil infusion (NR group, n = 224). The amount of fentanyl used and percentage of patients unable to eat supper were compared. RESULTS: Amount of fentanyl used in patients unable to eat supper were significantly higher than in patients able to eat supper in both NR and R groups. There is no difference in the percentage of patients unable to take supper between group NR and R. Total amount of fentanyl used was significantly lower in group R than in group NR. CONCLUSIONS: With or without the use of remifentanil, greater the amount of fentanyl used, greater the percentage of patients unable to eat. Amount of fentanyl used in R group was significantly less than in group NR; however the difference in percentage of patients unable to eat supper was not observed.

[Successful anesthetic management of a morbidly obese patient with the induction of general anesthesia and the laryngeal mask airway insertion in the lateral position].

A morbidly obese patient, with a body mass index of 43 kg m(-2), was scheduled to undergo open reduction and internal fixation (ORIF) to his left fibular fracture under general anesthesia in the lateral position. Before the induction of general anesthesia the patient positioned himself comfortably in right lateral. General anesthesia was induced with intravenous propofol and remifentanil infusions. Mask ventilation was performed easily. After establishment of mask ventilation, laryngeal mask airway (LMA) was inserted smoothly and an adequate airway was established with a LMA. ORIF was finished uneventfully. The patient remained in the lateral position until the emergence from general anesthesia. As soon as he awoke, LMA was removed in the lateral position. The patient turned to the supine position himself and was discharged to general ward. We consider our method, the induction of general anesthesia and the LMA insertion in the lateral position, was a selectable option to a morbidly obese patient who underwent an operation in the lateral position.

[Pulmonary artery obstruction in a pediatric patient during removal of a right ventricular myxoma].

Cardiac myxoma, especially right ventricular myxoma is very rare. We report a 2-year-old girl who underwent the emergent surgical resection of a right ventricular myxoma. She was noticed to have systolic murmur and was referred to our hospital. Echocardiography and magnetic resonance imaging (MRI) revealed the presence of tumor extending from the right ventricle across the pulmonic valve into the pulmonary artery. Anesthesia for the removal of a right ventricular myxoma should be carried out carefully, because pulmonary tract obstruction may occur during the procedure. During the removal of the tumor, the tumor obstructed the pulmonary artery resulting in severe decrease of the blood pressure and the heart rate. Because pulmonary artery occulusion occurred after pericardiotomy, chest massage was started quickly and in 15 minutes cardiopulmonary bypass was established. The tumor was removed completely and was diagnosed as myxoma by histological examination. The patient recovered uneventfully and was discharged without complications.

[Anesthetic management of concomitant off-pump coronary artery bypass grafting, pulmonary resection, and mastectomy].

Recently, an increasing number of patients with both ischemic heart disease and malignancy have underwent cardiac surgery and other operations simultaneously, as indication of off-pump coronary artery bypass grafting (OPCAB) has been expanded. A 66-year-old woman underwent OPCAB and other two operations for malignant diseases. General anesthesia was maintained by total intravenous infusion of propofol and fentanyl, and the patient's hemodynamics were kept stable throughout the operation under continuous administration of cardiotonics: dopamine, norepinephrine, and milrinone. The procedure for the operations was discussed in a conference with surgeons: 1. OPCAB 2. right middle and lower lobectomy and 3. right mastectomy. There were no postoperative complications.

[The transintervertebral disc approach for educational practice of the neurolytic celiac plexus block].

BACKGROUND: The transintervertebral disc approach was proposed recently for percutaneous neurolytic celiac plexus block (NCPB). Its superior simplicity, reliability, as well as safety potentially overcome the technical hurdles of NCPB that may interfere with the practical use of this validated analgesic intervention for abdominal cancer pain. The present study was conducted to evaluate the effectiveness of the use of this approach in a resident education program for NCPB. METHODS: The clinical results of NCPBs conducted from January 2001 to September 2002 were examined comparing that performed by institutional residents with that by specialized physicians authorized by the Japanese Society of Pain Clinicians. The transintervertebral disc approach was used in all cases. Each resident completed NCPB under close supervision of the specialists. RESULTS: Twenty-four patients received NCPB during the study period. Seven residents randomly completed 12 procedures and 4 specialists did others. The duration of fluoroscopy to complete the procedure was 256+/-109 sec in the resident group and 392+/-194 sec in the specialist group (ns). Significant pain reduction was obtained immediately after NCPB in all patients without any intergroup difference. No critical complication was observed in each group. CONCLUSIONS: The transintervertebral disc approach can be used effectively and safely in educational practice of NCPB for less-trained physicians.