[A case of acute exacerbation of interstitial pneumonia after appendectomy managed with spinal anesthesia].

An 88-year-old woman was admitted with acute appendicitis. She had been treated with prednisolone and home oxygen therapy for interstitial pneumonia. Her respiratory state on admission was Grade 2 of Hugh-Jones' classification, and plasma KL-6 and SP-D levels were high. Seven days after the admission, appendectomy was performed under spinal anesthesia. Spinal anesthesia was initiated by injecting 0.5% hyperbaric bupivacaine 2.0ml into L3-4 interspace, and achieved block level was up to T4. During the operation, her respiratory state was stable, but after the operation, dry cough, increase of body temperature, and dyspnea were observed. Chest roentgenogram revealed severe ground glass appearance and reticular shadows bilaterally. Steroid therapy for acute exacerbation of interstitial pneumonia was initiated, but she died on the 13th POD. This case teaches us to take a lot of care in the management of a patient with high plasma level of KL-6 and SP-D.

[Perioperative management of neuroleptic malignant syndrome in a schizophrenic patient scheduled to undergo operation for bowel obstruction].

Neroleptic malignant syndrome (NMS) is a serious side effect of antipsychotic medications. The risk factors for NMS are the patient's physiologic conditions such as dehydration, malnutrition, stress, and additional administration of sedative drugs including haloperidol. We report a case of 62-year-old schizophrenic man with bowel obstruction due to rectal cancer. Colostomy under general anesthesia was scheduled, and he had not taken oral medication. After intravenous injection of haloperidol for sedation, muscle rigidity, high fever, and an elevated serum level of creatine phosphokinase were observed. He was diagnosed as NMS, and sodium dantrolene was administered. After the improvement of NMS, colostomy was done. Dehydration and malnutrition of the patient were severe at the time of operation, and the possibility of NMS developing due to stress was thought to be very high. We administered sodium dantrolene to prevent NMS after the operation, and the management for prevention of NMS is discussed.

[Anesthetic management of the cesarean section in a patient with aplastic anemia].

A 31-year-old woman with aplastic anemia was admitted for the management of delivery at 33 weeks of gestation. Platelet count was 2.3 x 10(4) x microl(-1) on admission. Corticosteroid therapy after admission was not effective, and we decided to manage the delivery with elective cesarean section after platelet transfusion. After forty units of platelet transfusion, platelet count was 8.1 x 10(4) x microl(-1), and we decided to perform cesarean section under spinal anesthesia. Spinal anesthesia was given using a 25-gauge Quincke needle at L3-4 interspace, and 0.5% hyperbaric bupivacaine 2.5 ml with 0.15 mg morphine was injected. Block level was confirmed as T8 by a pinprick method. Blood loss during operation was 858 g, and complications were not seen during operation. In the case of delivery with uncontrolled aplastic anemia, elective cesarean section is thought to be safe. If platelet count is over 5.0 x 10(4) x microl(-1) after platelet transfusion, spinal anesthesia should be used.

[Anesthetic management of a patient with an ultra huge ovarian tumor].

We managed a patient with an ultra huge ovarian tumor weighing 48 kg. The patient was a 45-year-old woman and could not keep the supine position because of the respiratory disorder. Under local anesthesia with sedation, 28,000 ml of fluid was suctioned from the ultra huge ovarian tumor within about 2 hours in the left lateral position. The patient was turned into the supine position, and general anesthesia was induced. During the surgery, temporary oxygen desaturation and slight hypotension were observed after rapid suction from the ovarian tumor, but hemodynamic condition was almost stable. After extubation, respiratory and hemodynamic condition was good, and the patient had no postoperative complications. Anesthetic management of an ultra huge ovarian tumor is discussed.