[Anesthesia for a Patient with Acute Appendicitis and Idiopathic Cervical Internal Carotid Artery Vasospasms].

A 33 year-old female patient was admitted to the hospital with acute appendicitis. She had idiopathic cervical internal carotid artery vasospasms and had been taking aspirin. We used intracranial oxygen saturation measuring instrument (INVOS®) for anesthetic management during general anesthesia. We administered atropine and continuous small amount of dopamine, and loaded fluids when her blood pressure decreased. We refrained from using medicines which might influence cerebral blood flows. Intracranial oxygen saturation was maintained above baseline during the operation. Intracranial oxygen saturation measuring instrument was useful in achieving the maintenance of intracranial environment Administration of dopamine and atropine was useful and safe in keeping the circulation dynamics and intracranial tissue oxygen saturation in this patient.

[General anesthesia for a boy with Wolf-Hirschhorn syndrome].

Wolf-Hirschhorn syndrome (WHS) is a rare chromosomal abnormality in which there is deletion of the short arm of chromosome no. 4. Features of the condition include severe psychomotor retardation, characteristic facies and various congenital midline fusion anomalies. We report the anesthetic management in a 6-year-old boy with WHS, scheduled for renal biopsy under general anesthesia. Anesthesia was induced and maintained with sevoflurane and nitrous oxide in oxygen. Mask ventilation was performed easily. After establishment of mask ventilation, laryngeal mask airway (LMA) was inserted smoothly without muscle relaxant and an adequate airway was established with a LMA. He has episodes of transient deterioration in renal function with physical stress. To decrease renal effects of perioperative stress, transversus abdominis plane (TAP) block and intravenous patient controlled analgesia (IV-PCA) were administered for postoperative analgesia. The operation ended without any complications. Anesthetic emergence was rapid and he had no pain and decline in renal function.

[Use of cryoprecipitate for dilution coagulopathy in a 7-month-old infant].

We experienced a case of dilution coagulopathy successfully treated with cryoprecipitate. A seven-month-old male infant with tetralogy of Fallot and right femoral arteriovenous fistula had undergone a modified Blalock-Taussig shunt at 63 days of age. He was scheduled to undergo complete repair of TOF and closure of femoral arteriovenous fistula. The patient was transferred to the operating room with tracheal intubation. Anesthesia was induced with midazolam and fentanyl and maintained with sevoflurane and fentanyl. Before cardiopulmonary bypass (CPB), femoral arteriovenous fistula was corrected. Then complete repair of TOF was performed under CPB. Massive bleeding was observed and laboratory results showed low plasma fibrinogen level (45 mg x dl(-1)). Cryoprecipitate 2 units were given and fibrinogen level was restored (171 mg x dl(-1)). Bleeding quickly slowed down sufficiently for weaning from CPB. The patient was separated easily from CPB on dopamine and dobutamine infusion. Post-CPB bleeding was minimal and the patient was transferred to intensive care unit. The patient was discharged from the hospital on postoperative day 50. In the present case, dilution coagulopathy occurred as a result of the combination of excessive fluid infusion due to massive bleeding and blood dilution due to CPB. Fresh frozen plasma could have been contraindicated to supplement fibrinogen because the patient's body weight was low. Cryoprecipitate, a highly concentrated source of fibrinogen, was effective for correcting fibrinogen deficit.