[Epidural anesthesia at the L1-2 interspaces enables ambulation after cesarean delivery within less than 3 hours 30 minutes--a new perspective in the use of epidural anesthesia in cesarean deliveries].

BACKGROUND: In cesarean deliveries, it is important to prevent deep vein thrombosis in the lower limbs as this can result in pulmonary embolisms. Taking post-operative analgesia into account it is preferable to use an anesthesia method that allows early ambulation of patients. It is therefore necessary to use epidural anesthesia as a sole anesthesia method for cesarean deliveries. METHODS: In an analysis of 633 cesarean delivery patients who had been administered only epidural anesthesia, we investigated and compared the time to ambulation and cessation of continuous epidural infusion in groups that had received epidural puncture either at L1-2 or L2-3 space. RESULTS: The postoperative time to ambulation in the L1-2 puncture group was 189.9 ± 56.1 minutes. Postoperative analgesia administered via continuous epidural infusion of local anesthetic was discontinued due to remaining paralysis in 2.5% of the L1-2 puncture group, which was significantly lower than the L2- 3 puncture group (7.6%). CONCLUSIONS: Our findings showed that it is possible to utilize only epidural anesthesia for cesarean deliveries. Using lumbar epidural anesthesia with L1-2 puncture reduced a postoperative time to ambulation to less than 3 hours 10 minutes.

[Anesthetic management of an ALS patient with remifentanil].

An 82-year-old woman with amyotrophic lateral sclerosis (ALS) with bulbar paralysis, respiratory muscle paralysis, and arteriosclerosis obliterans (ASO) of the lower extremities, underwent uneventful general anesthesia with remifentanil and sevoflurane for bilateral below-knee amputation. Remifentanil is a potent ultra short-acting opioid analgesic drug, undergoes rapid metabolism by non-specific tissue and plasma esterases, and does not accumulate to any clinically important degrees. Furthermore, when remifentanil is used together with propofol during anesthetic induction, successful tracheal intubation can be accomplished without muscle relaxants. These features of remifentanil make it an ideal agent for use in patients with neuromuscular diseases, including ALS, with higher risks of postoperative opioid-induced respiratory depression.