[Lower thoracic epidural analgesia improves postoperative analgesia following vaginal total hysterectomy].

BACKGROUND: In our hospital, lumbar epidural analgesia had been used for postoperative analgesia following vaginal total hysterectomy (VTH). But some patients experienced severe abdominal pain or numbness of the legs. Therefore we planned a randomized prospective study to compare lower thoracic epidural analgesia and lumbar epidural analgesia following VTH. METHODS: Fifty patients were allocated to two groups: those who received lower thoracic epidural analgesia(T group)and the other who received lumbar epidural analgesia (L group). Both groupsreceived the same continuous epidural analgesia using fentanyl and ropivacaine after the operation. RESULTS: The T group required significantly lower frequency of analgesic agents compared with that of the L group (2.5±1.9 times vs. 1.2±1.1 times, P< 0.05). Fewer patients in the T group had felt numbness in their legs compared to the L group (8% vs. 55%, P<0.05). CONCLUSIONS: Lower thoracic epidural analgesia is more effective to provide postoperative analgesic effect following VTH compared with lumbar epidural analgesia.

[Two cases of anaphylactoid reaction after administration of sugammadex].

Anaphylaxis during anesthesia is a rare but life-threatening event. Sugammadex is a recently introduced drug that was specifically designed for the reversal of rocuroium and vecuronium-induced neuromuscular block. We describe the cases of a 74-year-old man and a 29-year-old man who developed an anaphylactoid reaction to sugammadex, presenting with cardiovascular collapse. Initial management consisted of fluid administration and intermittent i.v. ephedrine, epinephrine, and hydrocortisone. The patients made uncomplicated recovery and were discharged.

[Anesthetic management of a patient with Becker muscular dystrophy].

We experienced anesthetic management of a patient with Becker muscular dystrophy. He had advanced dilated cardiomyopathy and high serum CK in the preoperative examinations. Anesthesia was planned to avoid triggering malignant hyperthermia or rhabdomyolysis and hemodynamic changes. Propofol, remifentanil and a minimum dose of rocuronium bromide were used for anesthetic induction and maintainance. Arterial pressure, cardiac output and stroke volume variation were monitored by Flotrac sensor. There were no adverse events observed during the anesthetic management. In conclusion, total intravenous anesthesia with the administration of rocuronium and circulatory monitoring by Flotrac sensor could be safe and efficient for anesthetic management of patients with Becker muscular dystrophy.

[Anesthetic management of a child with Angelman's syndrome].

Angelman syndrome is a hereditary disease described by Angelman. The clinical features of Angelman syndrome are characterized by mental retardation, puppet-like ataxia, easily excitable personality, seizures, paroxysmal laughter, strabismus and macroglossia. A 4-year-old girl with Angelman syndrome underwent strabismus repair under general anesthesia. Anesthesia was slowly induced with sevoflurane in oxygen and maintained with air, oxygen, propofol and remifentanil. Tracheal intubation was performed after administration of rocuronium. During and after anesthesia, no adverse events regarding circulatory and respiratory systems occurred. However, this case demonstrates that it is necessary to pay attention to airway troubles including the difficulty of tracheal intubation, management of body temperature and chronotropic action or respiratory depression by anesthetic agents.

[Effects of landiolol on cardiovascular responses, bispectral index and body movement during endotracheal intubation].

BACKGROUND: We investigated the effects of a novel highly cardioselective short-acting beta-blocker, landiolol, on cardiovascular response, bispectral index and body movement during endotracheal METHODS: Forty ASA class 1 patients were randomly allocated into 2 groups, in a double-blind fashion; 1) 20 patients received landiolol 125 microg x kg(-1) x min(-1) for one minute followed by 40 microg x kg(-1) x min(-1) (landiolol group), and 2) 20 patients received saline (control group). Landiolol or saline was started 6 min after a target controlled infusion of propofol (effect-site concentration 4 microg x ml(-1)). The trachea was intubated 11 min after propofol infusion. Heart rate, mean arterial pressure, and bispectral index were recorded. In addition, the "isolated forearm" technique was used to detect body movement during endotracheal intubation. RESULTS: Maximum changes in heart rate (control; 48% versus landiolol; 19%), mean arterial pressure (51% versus 39%), and bispectral index (31% versus 12%) observed during endotracheal intubation were significantly less in the landiolol group. More patients in the control than in the landiolol group moved after endotracheal intubation (19 versus 11, P<0.05). CONCLUSIONS: Our results suggest that landiolol infusion was effective to attenuate the hemodynamic, arousal and somatic responses to endotracheal intubation.