[Anesthetic management for a child with bilateral pheochromocytoma].

We report anesthetic management for a 13-year-old boy undergoing surgical removal of the bilateral adrenal pheochromocytoma. His blood pressure was well-controlled at the time of the operation with an alpha-adrenergic receptor-blocking agent and a calcium channel blocker. His laboratory test, however, showed anemia and prolonged clotting time. Therefore, we preoperatively transfused leukocytes reduced red cells concentrates and fresh frozen plasma. General anesthesia with sevoflurane, propofol, fentanyl combined with thoracic epidural anesthesia was administered. During the surgery, continuous infusion of sodium nitroprusside, and bolus dose of nifedipine and phentolamine were used to control hypertension. Dopamine and noradrenaline were used to prevent the hypotension after the ligation of the adrenal veins. Balanced anesthesia technique provided relatively stable hemodynamics throughout the operation.

[Ilioinguinal nerve block during general anesthesia for inguinal herniorrhaphy in adult anticoagulated patients].

Two adult anticoagulated patients after valve replacement were scheduled for inguinal herniorrhaphy. For inguinal herniorrhaphy in adults, spinal anesthesia is a common anesthetic method. In order to avoid spinal hematoma due to spinal anesthesia, however, we employed general anesthesia combined with ilioinguinal nerve block. Following induction of anesthesia, a laryngeal mask airway was inserted. Ilioinguinal nerve block was performed with 0.25% bupivacaine 20ml. Ilioinguinal nerve block was effective for maintaining hemodynamic stability throughout the operation, and decreased postoperative pain. This technique appears to be a simple and safe method for providing effective and long-lasting perioperative analgesia following inguinal herniorrhaphy in adult patients.

[Ilioinguinal/iliohypogastric nerve block for pediatric inguinal herniorrhaphy; evaluation of the dose of ropivacaine].

BACKGROUND: The aim of this study was to investigate the appropriate dose of ropivacaine in efficacy and safety when administered for ilioinguinal/iliohypogastric nerve block in children undergoing inguinal herniorrhaphy. METHODS: Forty six children (aged 1-8 yr, classified ASA I-II) undergoing ambulatory surgery for inguinal herniotomy were randomly assigned to one of the three groups, according to the dosage of ropivacaine: group I (n = 15), group II (n = 16) and III (n = 15) received 1.875, 0.9375 and 0.5625 mg x kg(-1) of ropivacaine, respectively. Intraoperative hemodynamics and modified CHEOPS score at 1, 3 and 5 hours after operation were recorded. RESULTS: There were no significant differences among the three groups in the intraoperative hemodynamics, whereas postoperative modified CHEOPS scores were significantly higher in group III than the other groups. Trivial femoral nerve palsy occurred in one patient of the group II, and no other adverse effects were seen in any groups. CONCLUSIONS: These results suggest that more than 0.9375 mg x kg(-1) of ropivacaine might be recommended to obtain sufficient postoperative analgesia for the ilioinguinal/iliohypogastric nerve block in children undergoing inguinal herniorrhaphy.

[Effects of amrinone in patients undergoing off-pump coronary artery bypass grafting].

We evaluated the effect of amrinone in 41 patients undergoing off-pump coronary artery bypass grafting(CABG) retrospectively. Amrinone was intravenously administered at the rate of 5 mcg.kg-1.min-1 after coronary artery anastomosis (A 1 group: 11 cases) or after induction of anesthesia(A 2 group: 13 cases). The hemodynamic variables and use of concomitant drugs were compared among A 1, A 2 and the non-amrinone group (control group: 17 cases). Hemodynamics was measured before, during, after coronary artery anastomosis, and after the chest closure. Catecholamine and vasodilator were used to maintain mean arterial pressure (> 60 mmHg) and cardiac index(> 3.0 l.min-1.m-2). Mean pulmonary artery pressure, right atrial pressure and pulmonary artery wedge pressure were significantly higher during anastomosis than before anastomosis in control and A 1 group, but no significant changes in these parameters were observed in A 2 group. In addition, these variables increased significantly after chest closure in control group, but were unchanged in A 1 and A 2 groups. Patients with concomitant use of catecholamine and vasodilator in A 2 group were fewer than those in control and A 1 group. In conclusion, in the patients undergoing off-pump CABG, infusion of amrinone was recommended from the end of the induction of anesthesia.

[Paradoxical embolism during MIDCAB surgery].

A 36-year-old woman underwent MIDCAB surgery. During the exposure of LAD, the right ventricular wall was injured. The bleeding was controlled by compression. After that, she developed hypotension followed by cardiac arrest. At the same time, TEE showed bubbles in all of the right ventricle. The open chest massage and epinephrine 1 mg restored the heart beat. It was thought that bubbles were brought to the right ventricle via the injured wall by the blower. A few minutes after the cardiac arrest, bubbles were detected in the left atrium by TEE. This phenomenon was suspected as transpulmonary paradoxical embolism because no cardiac shunt could be detected by TEE.

[Incidence and duration of hoarseness following endotracheal intubation].

The incidence and duration of hoarseness following tracheal intubation with general anesthesia were studied retrospectively from November 1998 to October 2000 in postanesthetic clinic of Nara Medical University. Total number of patients was 3977 and 37.1% of them complained of hoarseness. Most of there patients recovered within three days after surgery but in 4.2% the hoarshness persisted over ten days and in 0.7% persisted over one month after surgery. Most of these persistent hoarseness were considered to have originated from surgical procedures (such cervical, pulmonary, cardioaortic operation, etc.) and those following only tracheal intubation recovered within two months after surgery. The hoarseness decreased the satisfactory level for anesthesia in 1.0% of total patients and 12.8% of patients with persistent hoarseness. We consider that preoperative explanation and postoperative communication by anesthesiologists are important.