The ultrasound-guided nerve blocks of abdominal wall contributed to anesthetic management of cholecystectomy in a patient with Becker muscular dystrophy without using muscle relaxants.

Becker muscular dystrophy (BMD) is a progressive neuromuscular disorder caused by mutations in the dystrophin gene. The sensitivity to non-depolarizing muscle relaxant in a patient with muscle dystrophy is reportedly higher than that in normal individuals, and the duration of the effect is known to be prolonged. In this report, we present the case of a 58-year-old man with BMD who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis under total intravenous anesthesia without the use of muscle-relaxant drugs and supplemented with regional anesthesia. Anesthesia was induced and maintained with propofol, remifentanil, and fentanyl; ultrasound-guided bilateral rectus sheath block (RSB) and right-sided subcostal transversus abdominis plane block (TAP) were performed. The procedure required conversion to open surgery because of hard conglutination; intraoperative and postoperative periods were uneventful. Adequate analgesia was maintained after extubation because of the effect of RSB and TAP.

[Effects of RSB and TAPB on Postoperative Pain in Laparoscopic Cholecystectomy].

BACKGROUND: Several reports have examined meth- ods to control pain after a laparoscopic cholecystec- tomy (LC) and have shown regional anesthesia to be an effective method. We had been performing LC using simple general anesthesia (G); however, in 2013, we adapted a rectus sheath block (RSB), and in 2014, we used a combination of RSB and a subcostal transversus abdominis plane block (TAPB) on the right side. We report on the transition from G to regional anesthesia in LC and its effect on postoperative pain. METHODS: We anesthetized three groups of patients undergoing LC. Group 1 received G (n =32) ; group 2 received RSB (n=28); and group 3 received a combination of RSB and TAPB (n=31). Patients used the numeric rating scale (NRS) to record their levels of postoperative pain, and the scores were compared for each group. RESULTS: No significant differences were noted in NRS scores between the G and RSB groups; however, the scores in the RSB group tended to be lower. NRS scores were significantly lower in the RSB-TAPB group than in both the RSB and G groups. CONCLUSIONS: This study showed that the combina- tion of RSB-TAPB effectively controlled pain after LC and lowered NRS scores.

[Unilateral Thoracic Paravertebral Block for Effective Control of Pain : A Case Report of a Patient with Esophageal Cancer and Cirrhosis of the Liver.]

We report a case in which unilateral thoracic para- vertebral block was used to effectively control pain in a 78-year-old male patient with Child's A liver cirrhosis and esophageal cancer. Epidural anesthesia was con- sidered risky in this case because of the low platelet count from cirrhosis. Therefore, we performed a unilat- eral thoracic paravertebral block and cannulation under general anesthesia. We administered 0.33% levobupi- vacaine 10 ml through the catheter for intraoperative analgesia. After the operation, we confirmed the place- ment of the catheter with a chest X-ray image : then, the patient was extubated and returned to the ward. Three hours after the operation, the patient com- plained of pain in his wound : hence, 0.33% levobupi- vacaine 5 ml was injected through the catheter, which effectively controlled pain for 10 hours. Further injec- tions were done 13 and 21 hours after the operation, and the catheter was removed 21 hours after the operation. While the catheter was in place, the patient scarcely complained of pain. The unilateral thoracic paravertebral block covered the wide range of wounds and provided good analgesia for the patient.

[Retrospective evaluation of predictors and frequency of hypotension in hypertensive patients after induction of general anesthesia].

BACKGROUND: It is reported that hypotension during general anesthesia is associated with adverse outcomes in patients having both noncardiac and cardiac surgery. The present retrospective study was undertaken to evaluate the incidence and the predictors of hypotension after induction of general anesthesia (GA) until the start of operation. METHODS: After the IRB approval, 157 patients with hypertension who had undergone surgery under general anesthesia were enrolled. Data were collected using medical chart and anesthesia record. We divided the period into two intervals, from entering the operating room to tracheal intubation (first interval) and from tracheal intubation to start of operation (second period). Hypotension was defined when blood pressure decreased more than or equal to 25 percent compared to blood pressure measured at first in operating room. RESULTS: Hypotension occurred in 73.2% during the first interval and 96.8% during the second interval. The age was a significant predictor for hypotension during the second interval (P = 0.0087). CONCLUSIONS: The result in this study indicated that the age was a significant predictor for hypotension from tracheal intubation to start of operation.

[Intraoperative acute airway obstruction due to the damage of a reinforced endotracheal tube in thyroidectomy].

A 55-year-old woman was scheduled for left thyroidectomy. Anesthesia was induced without problems and maintained without nitrous oxide. Sixteen minutes after the start of the procedure, airway pressures and endtidal carbon dioxide concentration increased suddenly. An attempt to pass a suction catheter down the endotracheal tube was unsuccessful. A protuberance was found in the reinforced endotracheal tube. After reintubation with a new reinforced endotracheal tube, ventilation was improved immediately. The rest of the procedure was done uneventfully. Similar phenomenon was reported in the reuse of endotracheal tube and the use of nitrous oxide. In our case, airway obstruction was caused by the pinhole that was created in a manufacturing process. We have to keep in mind that endotracheal tube itself may be out of order if other causes have been excluded.

[Prophylactic use of droperidol for postoperative nausea and vomiting following gynecological laparoscopic surgery under total intravenous anesthesia].

BACKGROUND: Propofol and droperidol decrease the incidence of postoperative nausea and vomiting (PONV). We investigated the incidence of PONV after total intravenous anesthesia (TIVA) with propofol alone versus combined use of droperidol and propofol. METHODS: Eighty three patients, who had undergone laparoscopic gynecologic surgery with TIVA using propofol and fentanyl, were retrospectively evaluated whether droperidol had affected the incidence of early (up to six hours postoperatively) and late (6-24 hours postoperatively) PONV. Group D (46 patients) received droperidol intravenously at the end of surgery. Group N (37 patients) received no droperidol. RESULTS: The incidences of early nausea were 27% in Group N and 4% in Group D (P<0.01). The incidences of early vomiting were 0% in Group N and 8% in Group D. The incidences of late nausea were 14% in Group N and 13% in Group D. The incidences of late vomiting were 3% in Group N and 7% in Group D. CONCLUSIONS: Droperidol was useful in reducing the incidence of early nausea and vomiting after total intravenous anesthesia with propofol and fentanyl in the patients undergoing laparoscopic surgery.