[Anesthetic management of an adult patient with tracheobronchomalacia].

General anesthesia was successfully performed in an 86-year-old woman with severe tracheobronchomalacia Tracheobronchomalacia in adult is a very rare disease, characterized by weakness of the trachea and bronchi, causing luminal narrowing during expiration. The patient had laparoscopic cholecystectomy. We used propofol, remifentanil, and rocuronium for induction of anesthesia. For maintenance of anesthesia, oxygen, air, propofol, fentanyl, and remifentanil were used. After the end of operation, we used sugammadex to reverse neuromuscular blockade by rocuronium. The patient showed spontaneous breathing and good awareness, and we extubated. The patient did well, and was discharged from the hospital 3 days after the operation. In this case, no special care such as postoperative CPAP was necessary, but normally, general anesthesia for a patient with tracheobronchomalacia requires attention. We gave general anesthesia satisfactorily in a patient with tracheobronchomalacia.

[Use of remifentanil in a patient with renal failure and liver dysfunction undergoing hepatectomy].

A 74-year-old woman was scheduled for a hepatectomy. Delayed emergence from anesthesia was anticipated because she had renal failure and liver dysfunction. We induced and maintained anesthesia for 478 minutes with propofol and remifentanil. The intraoperative course was uneventful and emergence from anesthesia was not delayed. Spontaneous respiration returned and her trachea was extubated 15 minutes after the surgery. Postoperative analgesia was established by epidural ropivacaine. This case shows that remifentanil is effective in anesthetic management for a patient with renal failure and liver dysfunction undergoing hepatectomy due to its unique mode of metabolism.