[Epidural anesthesia for femoral head replacement in a spinocerebellar ataxia patient: a case report].

Perioperative management of a spinocerebellar ataxia patient by epidural anesthesia is reported. A 67-year-old woman with left femur neck fracture underwent femoral head replacement. An epidural catheter was placed without difficulty at the L3-4 interspace using the loss of resistance technique. A total of 1% mepivacaine 13 ml was administered in divided doses to obtain bilateral T5 analgesic level. Hypotension (79 mmHg systolic) was observed transiently, and ephedrine 8 mg was administered which successfully elevated blood pressure. Overall, hemodynamics and respiratory status were stable. Postoperative analgesia was maintained by infusion of 0.2% ropivacaine at 2 ml x hr(-1). The patient's postoperative course was uneventful, and her neurologic conditions remained unchanged.

[Continuous infusion of low-dose remifentanil for palliation of pain with epidural catheterization].

BACKGROUND: To prospectively determine the safety and effectiveness of continuous infusion of low-dose remifentanil for the reduction of pain in patients for epidural catheterization. METHODS: This study was approved by the institutional review board. Written informed consent was obtained. Fifty two patients (27 men, 25 women, age range 16-96 years, mean age 68 years) were given continuous infusion of various rates of application (none, 0.02, 0.05, and 0.07 microg x kg -1 x hr-1) of remifentanil. Blood pressure, heart rate, pulse oximetry oxygen saturation and respiratory rate were recorded during the procedure of epidural catheterization. Pain score was measured with the visual analogue scale (VAS), and complications including muscle stiffness, nausea and vomiting, and depressed level of consciousness were monitored. RESULTS: Every rate of application, pulse oximetry oxygen saturation and systemic blood pressure were decreased but the reduction was not marked. The muscle stiffness, nausea and vomiting, and depressed level of consciousness were not observed in all the cases. No other serious complications were observed. CONCLUSIONS: Continuous infusion of low-dose remifentanil is a safe and effective method for palliation of pain in epidural catheterization.

[Anesthetic management of a patient with amyotrophic lateral sclerosis (ALS)].

A 63-year-old man suffering from amyotrophic lateral sclerosis (ALS) was scheduled for a surgery of rectal cancer. Anesthetic management was planned aiming early recovery from anesthesia and reduction of muscle relaxant administration. Orotracheal intubation was carried out by intravenous administration of a comparatively large dose propofol (3 mg.kg-1) and sevoflurane as high as 5%. Adequate muscle relaxation was obtained throughout the operation by inhalation of 2-3% sevoflurane and single intravenous administration of vecuronium 1 mg. A combination of propofol and sevoflurane is a successful choice to eliminate effects of anesthesia early after surgery and also to reduce the amount of a muscle relaxant used.