Postoperative neuroleptic malignant syndrome that occurred repeatedly in a patient with cerebral palsy.

A wide variety of neuroleptic agents are associated with neuroleptic malignant syndrome (NMS). However, the association between general anesthesia and NMS is uncertain. We report a case of a patient with cerebral palsy, who showed signs of NMS only after repeated general anesthesia. The patient received general anesthesia three times in a period of 9 months. The first anesthetic passed uneventfully. NMS symptoms were observed only after the second and third anesthetics. The NMS was effectively treated with IV dantrolene and the patient recovered on both occasions. Inhalational anesthetics, muscle relaxants and fentanyl were suspected as possible triggering factors for NMS. After examining the three anesthesia records and previous publications, we surmized that a nondepolarizing muscle relaxant was associated with NMS in this patient.

A case report of anesthetic management of the minimally invasive Nuss operation for pectus excavatum.

We describe the anesthetic management of a patient with pectus excavatum, receiving the minimally invasive Nuss operation, which corrects chest wall deformity by insertion of a convex steel bar (pectus bar). An 8-year-old female patient was scheduled for the Nuss operation. The manipulation of the bar in the thorax was guided by thoracic endoscopy. Anesthesia was maintained with a combination of general and epidural anesthesia. The intraarterial catheter and epidural catheter were inserted after the induction of general anesthesia. During the manipulation of the pectus bar in the anterior mediastinum, a sudden decrease in arterial pressure might occur due to the compression of the heart. Therefore, the intraarterial line was essential for continuous monitoring of arterial pressure. The pectus bar causes severe postoperative pain, and the patient was required to remain at bed rest for several days. Continuous epidural infusion of ropivacaine and morphine eliminated the postoperative pain and enabled the patient to maintain bed rest. For the anesthetic managements of patients undergoing the Nuss operation, close monitoring of arterial pressure intraoperatively and postoperative analgesia are important.

Preoperative assessment of hepatic function: Utility of a new convenient two-compartment model analysis using galactosyl human serum albumin scintigraphy.

BACKGROUND AND AIM: Preoperative hepatic function was evaluated using technetium-99 m-diethylenetriaminepenta-acetic acid-galactosyl-human serum albumin (Tc-GSA) and a scintillation camera to detect hepatic Tc-GSA uptake by the asialoglycoprotein receptor. METHODS: Sixty-two preoperative patients with liver cancer, including hepatocellular and cholangiocellular carcinomas, were studied, using two-parameter two-compartment model analysis. This model is simpler than either the three- or five-compartment model, both of which are accurate but which require complicated analysis and enormous calculation. The parameters k1 and k2 represented the transfer rate constant from the blood to the liver and from the liver to the blood, respectively. We calculated k1, k2, and k1/k2 from time-radioactivity curves of the heart and liver as well as VLmg, which represented the maximal amount of Tc-GSA in the liver. RESULTS: The results were compared to those of conventional liver function analysis using Tc-GSA (the index of blood clearance (HH15) and the receptor index (LHL15)) or indocyanine green (ICGR15). Both HH15 and LHL15 were significantly correlated with k1, k1/k2, and VLmg. In addition, they closely correlated with the results of ICGR15 and some serum hepatic function tests (aspartate aminotransferase, choline esterase, albumin, platelet). The pathological grading for liver cirrhosis also correlated with k1, k1/k2, and VLmg. From a clinical point of view, VLmg had a significant correlation with the Child-Pugh score. CONCLUSIONS: These results suggest that this new compartment analysis will be useful in evaluating liver function, as it is accurate, simple and convenient.