[Anesthetic management with remifentanil for tracheobronchial stent insertion].

BACKGROUND: Although remifentanil produces respiratory depression, its very short duration of action provides a great advantage for the control of hemodynamics during anesthesia for tracheobronchial stent insertion. We compared remifentanil with fentanyl during propofol-based anesthesea for anesthetic management for tracheobronchial stent insertion. METHODS: Seventy-eight patients were analyzed retrospectively by anesthetic chart review. Thirty-nine patients were anesthetized with bolus infusion of fentanyl with propofol (group PF). The remaining 39 patients were anesthetized with continuous infusion of remifentanil with propofol (group PR). Demographic data, duration of anesthesia and operative procedure, airway management, duration of emergence, dose of propofol, fentanyl and remifentanil, and use of cardiovascular drug were analyzed for the 2 groups. Chi-square tests and Student-t test were used for statistical analysis. Differences were considered significant when P was below 0.05. RESULTS: The dose of propofol was less in the PR group than in the PF group (0.10 +/- 0.04 mg x kg(-1) x min(-1) vs. 0.14 +/- 0.04 mg x kg(-1) x min(-1), P = 0.025). The duration of emergence was shorter in the PR group than in the PF group (9.0 +/- 6.8 min vs. 12.5 +/- 6.2 min). CONCLUSIONS: We conclude that the continuous infusion of low dose remifentanil with propofol produce more efficient respiratory and hemodynamic stability than the bolus infusion of fentanyl with propofol during anesthesia for tracheobronchial stent insertion.

[Anesthetic management of concomitant off-pump coronary artery bypass grafting and complete pneumonectomy for lung cancer].

A 69-year-old man was scheduled for combined surgery involving off-pump coronary artery bypass grafting (OPCABG) for coronary stenosis and total pneumonectomy for lung cancer. Anesthesia was maintained with fentanyl, thiopental, sevoflurane, nitrous oxide, and epidural anesthesia using 1.0% mepivacaine. Although a steady hemodynamic circulation was maintained during OPCABG, it was difficult to stabilize the circulation during the total pneumonectomy.

Intravenous cyclophosphamide therapy in a case with refractory thrombotic microangiopathic hemolytic anemia and SLE.

The case of a 27-year-old woman who simultaneously presented with SLE and severe refractory thrombotic microangiopathic hemolytic anemia (TMHA) is reported. She had extremely high levels of platelet-associated IgG (PAIgG), and her TMHA was refractory to plasma exchange and corticosteroid therapy. However, the TMHA was effectively controlled by i.v. cyclophosphamide therapy. ITP and TTP are generally considered distinct diseases; however, TMHA may occur secondary to platelet aggregation via autoimmune mechanisms in certain cases. Immunosuppressive therapy at an early stage of the disease may be beneficial in refractory cases of TMHA with autoimmune features.

[The effect of repeated sevoflurane anesthesia on hepatic function and immunological system].

BACKGROUND: Sevoflurane is known as a useful and safe anesthetic because of its properties of fast uptake and elimination at the lungs and of no effects on hepatic function. In this study we examined the effect of repeated sevoflurane anesthesia on hepatic function and immunological system. METHODS: Eight patients (ASA, PS 2 or 3) received sevoflurane anesthesia three times in 6 months. Six patients had emergency operation for injuries. Aspirate transaminase (AST), alanine transaminase (ALT) and complements (CH50, C3, C4) were measured prior to anesthesia, and 1, 7 and 14 days after anesthesia. RESULTS: The values of AST and ALT were high prior to anesthesia at the first anesthesia. However, these were of no significant changes. CH50, C3, C4 increased significantly after the first anesthesia. However, there were no significant changes of these complements after the second and the third anesthesia. CONCLUSIONS: Our results suggest that sevoflurane is not likely to provide adverse effects on the liver and to suppress the production of complements accompanied by the surgical stress.