A Case of Sudden Shock during Caesarean Section in whi ch Amniotic Fluid Embolism is Suspected.

We report a case of sudden shock during caesarean section under combined spinal epidural anesthesia. The patient was a 29-year-old woman. During the operation vital signs had been almost stable until a female-baby was born. But after the delivery of the placenta, the patient developed an episode of coughing and dyspnea followed by unconsciousness and bradycardia. She was given adrenaline and intubated, appearing ventricular fibrillation on a EKG. Cardiopulmonary resuscitation was immediately started and sinus rhythm returned. Hypotension followed and a small dose of adrenaline was infused for three days. She made good progress and was discharged without significant sequela. Cardiopulmonary collapse type of amniotic fluid embolism (AFE) is doubtful in this case. The necessity of rapid and appropriate treatment for emergency obstetric cases was discussed.

[Anesthetic Management of Two Patients with Chilaiditi Syndrome].

Chilaiditi syndrome is assosiated with hepatodiaphragmatic interposition of the colon and the small intestines. We anesthetized 2 patients with Chilaiditi syndrome. A 62-year-old woman with interposition of the intestine was scheduled for right femoral fibrosarcoma resection. She had been medicated for schizophrenia. Total intravenous anesthesia was induced and maintained. Another patient an 81-year-old man with interposition of the colon, was scheduled for transurethral resection of a bladder tumor. He was anesthetized with spinal anesthesia. In both cases, there was no cardiovascular complication or digestive disorder during the perioperative period.

[Postoperative pain management using subcutaneous fentanyl and ketamine after abdominal gynecologic surgery].

BACKGROUND: Subcutaneous opioid is one way of managing postoperative pain in patients undergoing anticoagulant therapy. We have evaluated the safety and the efficacy of postoperative pain management using subcutaneous fentanyl and ketamine after abdominal gynecologic surgery. METHODS: Written informed consent was obtained from 50 ASA physical status 1 or 2 female patients aged between 20 and 65. Patients were randomized to one of 5 groups. Group 1, 2 and 3 received 25, 35 and 50 microg x h(-1) subcutaneous fentanyl infusion, respectively. Group 4 received 25 microg x h(-1) fentanyl and 2 mg x h(-1) ketamine subcutaneously; group 5 received 25 microg x h(-1) fentanyl and 4 mg x h(-1) ketamine subcutaneously. General anesthesia was administered to all patients. Two hours after induction, subcutaneous infusion of fentanyl and ketamine was started in the patients and discontinued 24 hours after the operation. All patients were assessed twice, at 4 hours and at 24 hours after operation. Blood gas analysis was performed. Number of analgesic administration required during the 24 hours after operation was recorded. Groups 1, 2, 3 and groups 1, 4, 5 were evaluated as one group, respectively. Group differences were analyzed by variance analysis. Differences of analgesic administration were analyzed with Kruskal-Wallis test. RESULTS: As to anesthetic requirement during the 24 hours after operation, there were no significant differences among treatment groups. With respect to blood gas analysis, only individuals receiving subcutaneous 25 microg x h(-1) fentanyl and 4 mg x h(-1) ketamine maintained high PaO2 4 hours after the operation (P<0.05). CONCLUSIONS: We recommend administration of 25 microg x h(-1) fentanyl and 4 mg x h(-1) ketamine subcutaneously, which maintains high Pao2 and requires less analgesic.

[Comparison of 8 mg and 10 mg hyperbaric bupivacaine during spinal anesthesia for cesarean section in Japanese parturients].

BACKGROUND: Hypotension after spinal anesthesia for cesarean section is common and may result in serious complications despite the use of uterine displacement and volume preloading. Adequate amount of hyperbaric bupivacaine for Japanese parturients whose frames are generally smaller than those of Caucasian counterparts have not yet been examined. We compared the analgesic efficacy and the incidence of hypotension with 8 mg versus 10 mg hyperbaric bupivacaine during spinal anesthesia for cesarean section in Japanese parturients. METHODS: Thirty six parturients were randomly divided into two groups, one receiving 8 mg (n = 19) and the other receiving 10 mg (n = 17) hyperbaric bupivacaine. Sensory block level and the incidence of hypotension were evaluated from the time of injection to delivery. Hypotension was defined as a decrease in systolic blood pressure below 100 mmHg and to less than 80% of the baseline value. RESULTS: 15 minutes after spinal injection, the difference in sensory block level was not significant. Ten minutes after the spinal anesthesia, in 79% of 8 mg group and in 88% of 10 mg group, sensory block level reached T 4. Hypotension occurred in 19 parturients (7 in 8 mg group and 12 in 10 mg group). The incidence of hypotension was significantly lower in 8 mg group (37%) than in 10 mg group (71%). There were no significant differences either in neonatal Apgar scores or umbilical blood gas pH. CONCLUSIONS: Injection of 8 mg hyperbaric bupivacaine is preferable than 10 mg in spinal anesthesia for cesarean section to obtain adequate analgesic efficacy and to avoid maternal hypotension.

[Vocal cord palsy after the use of a laryngeal mask airway].

A 58-year-old woman underwent oophorectomy for an ovarian tumor. Anesthesia was maintained with epidural block, and propofol and fentanyl anesthesia using a laryngeal mask airway. After the operation, she complained of hoarseness and difficulty in swallowing. Right vocal cord palsy was found by a ENT surgeon. The condition returned to normal two months after the operation. We have to have in mind that vocal cord palsy may occur even if we use a laryngeal mask airway. At least we have to pay attention to intra-cuff pressures and the position of the laryngeal mask airway.

[Anesthetic factors that influence pH of neonatal umbilical artery from mothers in severe gestosis during cesarean section under sevoflurane anesthesia].

Twenty-two patients complicated with severe gestosis underwent cesarean section. General anesthesia was induced with intravenous thiopental and suxamethonium and maintained with sevoflurane below 1.5% with 40-50% oxygen and 50-60% nitrous oxide. Mean artery pressure at and after the induction as well as at the delivery, expired maternal sevoflurane concentrations at the delivery and neonate birth weight were measured for statistical analyses in relation with neonates pH of umbilical artery. Mean artery pressure at the delivery and neonates birth weight influence neonates pH of umbilical artery.