[Efficacy of remifentanil for anesthetic management of awake craniotomy].

BACKGROUND: Remifentanil has strong analgesic fore tried to use remifentanil for anesthetic management of awake craniotomy (AC) and assessed its efficacy. METHODS: The patients underwent AC with general anesthesia by propofol (P group, n = 17), or by propofol and remifentanil (PR group, n = 13), and were analyzed retrospectively. We investigated (1) systolic blood pressure (SBP) and heart rate (HR) until first 60 minutes after starting the operation, (2) the time from cessation of anesthetics to awakening for brain mapping, and (3) anesthetic complications. RESULTS: The patients in PR group were infused remifentanil by 0.22 +/- 0.06 microg x kg(-1) x min(-1) and all needed controlled ventilation with laryngeal mask airway. The increase of HR after starting the operation was lower in PR group (P < 0.01). The time to awakening was not significant by defference between them. In anesthetic complications, the incidence of movement during the general anesthesia was more frequent in P group (P < 0.01). Other complications occurred similarly and were controllable. CONCLUSIONS: Remifentanil is effective for anesthetic management of AC. However, respiratory management is necessary.

[Airway and respiratory management for anesthesia in the patients with severe motor and intellectual disabilities].

BACKGROUND: For the management of general anesthesia in the patients with severe motor and intellectual disabilities, airway and respiratory disorders are severe and may cause fatal events. We retrospectively examined these risk factors. METHODS: We assessed adverse airway and respiratory events associated with anesthesia from perioperative and anesthetic records of these patients retrospectively. RESULTS: Forty-one cases (31 were for fundoplication, and 10 were for gastrostomy or jejunostomy) were involved. On anesthetic introduction, in 9 cases tracheal intubation was difficult (failed in 1 case). These and other 4 cases had developed pharyngeal and laryngeal edema. Manual ventilation by facemask was successful in all cases. During the postoperative period, pneumonia (5 cases), pleural effusion (1 case), and apnea (2 cases) occurred unexpectedly. CONCLUSIONS: Patients with severe motor and intellectual disabilities belong to the group with high risk for general anesthesia.