[A Case of Neuroleptic Malignant Syndrome Associated with Undiagnosed Dementia with Lewy Bodies].

A 78-year-old woman was transferred to our hospital for clouded consciousness and a high fever. She had been diagnosed with Parkinsonian syndrome, which was controlled with amantadine. Hallucination appeared a week prior to the transfer and she was treated with haloperidol. Suspecting neuroleptic malignant syndrome, dantrolene sodium was administered along with symptomatic treatment with mechanical ventilation and cooling. Her symptoms were reversed and she was transferred to another hospital for neurological evaluation. Magnetic resonance imaging revealed dementia with Lewy bodies (DLB). The high drug sensitivity of DLB was considered the cause of neuroleptic malignant syndrome induced by haloperidol. DLB should be considered in neurological emergencies in patients with Parkinsonism.

Perioperative risk factors for deep vein thrombosis after total hip arthroplasty or total knee arthroplasty.

STUDY OBJECTIVE: To determine the perioperative frequency of deep vein thrombosis (DVT) after lower limb joint prosthesis surgery using Doppler ultrasonography (US). DESIGN: Prospective cohort study. SETTING: Operating room and hospital ward. PATIENTS: 144 consecutive ASA physical status 1 and 2 patients who underwent elective total hip arthroplasty (THA; n=64) or total knee arthroplasty (TKA; n= 80). INTERVENTIONS: Patients were allocated to two groups, those who developed DVT (DVT group) postoperatively and those who did not (no-DVT group). To examine the perioperative risk factors for DVT after THA or TKA, comparative analysis of the two groups was done. MEASUREMENTS: Doppler US was performed on all patients from the bilateral femoral to lower limb to detect the existence of DVT postoperatively. MAIN RESULTS: DVT was detected in 61 patients (42%), including three proximal DVT patients (2%). Preoperative elevated plasma D-dimer value [P = 0.0131, odds ratio (OR) 1.54, 95% CI 1.10-2.17] and history of hyperlipidemia (P = 0.0453, OR 6.92, 95% CI 1.04-46.00] were significant risk factors for the onset of DVT. A preoperative plasma D-dimer cutoff value as a diagnostic test was obtained as 0.85 µg/mL. CONCLUSIONS: A high preoperative plasma D-dimer value and/or history of hyperlipidemia were risk factors for DVT after THA or TKA.

[Assessment of factors leading to postanesthetic shivering in patients undergoing laparoscopic colectomy with total intravenous anesthesia using remifentanil].

BACKGROUND: It has been reported that postanesthetic shivering is associated with general anesthesia using remifentanil infusion. The aim of this retrospective study was to evaluate the factors leading to postanesthetic shivering. METHODS: The patient populations include patients who had undergone laparoscopic colectomy under total intravenous anesthesia with propofol, remifentanil infusion and fentanyl bolus administration. Preoperative clinical variables of interest included age, sex, height, weight, and body surface area. Intraoperative variables of interest included the duration of anesthesia and surgery, pharyngeal temperature at the beginning and the end of the surgery, predicted plasma and effect site concentration of fentanyl at the extubation and mean infusion rate of remifentanil. RESULTS: The authors identified 53 patients and 9 of them had shown shivering. In shivering group, the duration of anesthesia and surgery was significantly longer, and the predicted plasma and effect site fentanyl concentrations in extubated period were significantly lower. There was no significant difference in either background or core temperature. CONCLUSIONS: These data suggest that fentanyl concentration may be important for avoiding postanesthetic shivering and the duration of surgery may be a predictor for postanesthetic shivering.

[Management of intraoperative systolic anterior motion of the mitral valve after valve plasty: a case report].

We report a case of intraoperative systolic anterior motion (SAM) of the mitral valve after mitral valve plasty (MVP). A 53-year-old man underwent MVP for mitral regurgitation (MR). MVP was carried out uneventfully. We weaned the patient from cardiopulmonary bypass (CPB) with continuous administration of catecholamines and a vasodilator. However, after the weaning from CPB, transesophageal echocardiography (TEE) detected moderate MR with left ventricular outflow tract obstruction (LVOTO) due to SAM. LVOTO and SAM gradually disappeared after the reduction of catecholamines and volume loading. He was transferred to the intensive care unit postoperatively and extubated 18 hours after operation. Transthoracic echocardiography after operation revealed disappearance of MR. He was discharged from the hospital on postoperative day 15 without complications. We successfully managed MR with LVOTO due to SAM by reduction of catecholamines and volume loading.

[Three cases of acute pulmonary thromboembolism diagnosed by transesophageal echocardiography].

We report 3 cases of acute pulmonary thromboembolism (PTE) diagnosed by transesophageal echocardiography (TEE). In all these cases, cardiovascular state of the patient was unstable and therefore computerized tomography and catheterization of the pulmonary artery for diagnosis of PTE could not be performed. TEE was useful for diagnosis of acute PTE. All three patients passed away eventually and we had a difficult experience for treatment of acute PTE. We should take various measures against deep vein thrombosis for prevention of acute PTE.

[Anesthetic management for high-intensity focused ultrasound (HIFU) therapy in prostate cancer patients].

HIFU therapy is one of epoch-making, low-invasive treatments for prostate cancer. We investigated 71 patients who had undergone HIFU therapy from June 2004 through September 2005. We mainly gave a single spinal injection followed by epidural catheterization with a combined spinal-epidural anesthesia kit. Three patients received general anesthesia because of various problems such as allergy for local anesthetics, ankylosing spondylitis and severe spinal deformity causing difficulty in lumbar puncture. Spinal anesthesia was successfully achieved in most patients. Twelve patients with insufficient anesthetic levels required additional local anesthetics via epidural catheters. We found no serious perioperative complications.