[Increased dose of remifentanil caused difficult ventilation at emergence from general anesthesia].

Remifentanil induces a higher incidence of respiratory rigidity than other opioids, especially when it is given at bolus injection for anesthetic induction. A 71-year-old man underwent pharyngo-laryngeal surgery under general anesthesia with remifentanil and sevoflurane. At the end of surgery, the ventilation through a tracheal tube became difficult due to muscle rigidity simultaneously with the increased dose of remifentanil and the decreased sevoflurane concentration. It should be kept in mind that increased doses of remifentanil during as well as at the end of surgery cause difficult ventilation associated with muscle rigidity.

[Anesthetic management for a patient with severely obstructed upper airway undergoing CO2 laser resection of the tracheal tumor].

A 76-year-old woman was scheduled to undergo a laser resection of the tracheal tumor which severely obstructed the upper airway. She had a past history of thoracic aortic aneurysm resection and myocardial infarction. After spraying the patient's oral cavity with 8% lidocaine, a laryngeal mask airway was inserted under spontaneous respiration. Tumor resection was successfully performed using CO2 laser through the laryngeal mask airway with the aid of low dose fentanyl under spontaneous respiration. Maintaining FIO2 at 0.5 could prevent hypoxemia. Although mild edema was observed in the larynx at the completion of the surgery, the patient achieved remarkable improvement in her breathing status. Consequently, she was able to undergo radiotherapy on the 5th postoperative day. This effectively reduced the tumor volume.

Meningioma arising in Werner syndrome confirmed by mutation analysis.

OBJECTIVE AND IMPORTANCE: Meningioma arising in Werner syndrome has been described previously, but never in association with a mutation analysis. We present the first reported case of meningioma in a patient with Werner syndrome and a confirmed major mutation. In addition, we review 27 previously reported patients with meningioma associated with Werner syndrome. CLINICAL PRESENTATION: We report a 56-year-old Japanese woman with Werner syndrome and a meningioma. She presented with pain and redness of the right eye and a headache. Cranial CT revealed a tumor the in right frontal and temporal lobes. Pathological examination after surgical removal confirmed meningioma. She displayed typical features of Werner syndrome including juvenile cataract, short stature and low weight, a bird-like face, a hoarse voice, and dry, atrophic, pigmented skin. INVESTIGATION: To confirm the clinical diagnosis, a mutation analysis based on the mutant allele-specific amplification (MASA) method was performed. CONCLUSION: Mutation analysis of peripheral blood leukocyte DNA showed amplification of the mutation 4/4. There were 22 patients with Werner syndrome and meningioma reported from Japan and 5 from outside Japan. There was only one malignant meningioma. Meningiomas in Werner syndrome have a higher frequency in males and occur at a younger age than those of the general population.