Anesthesia for patient with anti-N-methyl-D-aspartate receptor encephalitis: A case report with a brief review of the literature.

Rationale: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an immune-mediated syndrome caused by the production of antibodies against NMDA receptors. As NMDA receptors are important targets of many anesthetic drugs, the perioperative management of patients with anti-NMDA receptor encephalitis is challenging for anesthesiologists.

Patient Concerns: A 31-year-old woman presented with akinesia and aphasia, which worsened despite steroid therapy.

Flocculation and pentadecane production of a novel filamentous cyanobacterium Limnothrix sp. strain SK1-2-1.

Objective: A novel filamentous cyanobacterium, a photosynthesizing microorganism, was isolated from a river, and its unique features of flocculation and pentadecane production were characterized.

Results: Microscopic observations and a phylogenetic analysis with 16S rDNA revealed that this strain was a Limnothrix species denoted as the SK1-2-1 strain. Auto cell-flocculation was observed when this strain was exposed to a two-step incubation involving a standing cultivation following a shaking preincubation.

Oral nutritional support can shorten the duration of parenteral hydration in end-of-life cancer patients: a randomized controlled trial.

Tube feeding or hydration is often considered for end-of-life cancer patients despite the negative effects on quality of life. The efficacy of oral nutritional support in this setting is unknown. We conducted a randomized trial to compare the efficacies of an amino acid jelly, Inner Power® (IP), and a liquid enteral product, Ensure Liquid® (EL), in terminally ill cancer patients.

[Two cases of bilateral upper extremity pareses during laparoscopic colectomy].

We herein report on two cases of bilateral upper extremity pareses developing after laparoscopic colectomy. The first case is a 42-year-old man undergoing laparoscopic colectomy under general and epidural anesthesia. During the operation, he was in a combined lithotomy and Trendelenburg position with his arms abducted to 80 degrees and flexed slightly on padded armboards.

[The change of difficulty in intubation as growth in patients with Treacher-Collins syndrome and Pierre-Robin syndrome].

Background: Previous reports revealed that difficulties in tracheal intubation for patients with Treacher-Collins syndrome (TCS) progresses as growth; however it declines in those with Pierre-Robin syndrome (PRS). We tried to confirm these reports.

Methods: We retrospectively examined the anesthetic records of intubated patients with TCS and PRS without tracheotomy from January 2002 to August 2006.

[Effects of linear polarized light irradiation around the lumbar sympathetic ganglion area upon the skin temperature of lower extremities].

Background: The effect of linear polarized light irradiation around the lumbar sympathetic ganglion area upon the skin temperature of legs may be similar to that of irradiation of near stellate ganglion area upon arms.

Methods: Linear polarized light irradiation was induced with SUPER LIZER (Tokyo Iken, Tokyo, Japan). The C probe of SUPER LIZER was placed on the left side of the supine at the level of L2.

Effects of deep hypothermic circulatory arrest with retrograde cerebral perfusion on electroencephalographic bispectral index and suppression ratio.

Objective: No systematic study has been conducted to investigate effects of deep hypothermic circulatory arrest (DHCA) on electroencephalographic bispectral index (BIS) and suppression ratio (SR). Thus, the effects of DHCA were evaluated on BIS and SR.

Design: A prospective clinical study.

Transient decreases in Bispectral Index without associated changes in the level of consciousness during photic stimulation in an epileptic patient.

This case report describes a patient with a history of epileptic seizures who showed unusual decreases in the Bispectral Index (BIS) attributable to the induction of abnormal slow electroencephalographic (EEG) waves by photic stimulation, without any associated decrease in his level of consciousness. After starting anticonvulsive therapy, photic stimulation no longer induced abnormal EEG activity nor decreased BIS values. These findings suggest that BIS values may not accurately reflect a patient's actual level of consciousness in the presence of epilepsy-related abnormal EEG activity and that the BIS monitor may be able to track such EEG changes.

[Outline and effectiveness of support system in the surgical center by supply, processing and distribution center (SPD)].

Supply, Processing and Distribution system had been introduced to surgical center (the University of Tokyo Hospital) since October of 2002. This system had reduced stock for medicine and materials and decreased medical cost dramatically. We designed some kits for therapeutic drugs related to anesthesia.

Change in bispectral index during epileptiform electrical activity under sevoflurane anesthesia in a patient with epilepsy.

Unlabelled: We observed abnormal fluctuation in Bispectral Index (BIS) caused by repeated alternations between two electroencephalographic (EEG) waveform patterns in a patient with a recent history of epileptic seizure under sevoflurane anesthesia. The repetitive development of the abnormal EEG changes (slow delta with or without spike) and the fluctuation in BIS disappeared almost immediately after administration of anticonvulsants. BIS may give useful information not only on the sedative-hypnotic state, but also on the development of and recovery from abnormal epileptiform EEG activity.

Cerebral ischaemia during cardiac surgery in children detected by combined monitoring of BIS and near-infrared spectroscopy.

Background: Children frequently suffer transient cerebral ischaemia during cardiac surgery. We measured cerebral ischaemia in children during cardiac surgery by combining two methods of monitoring.

Methods: We studied 65 children aged between 5 months and 17 yr having surgery to correct non-cyanotic heart disease using hypothermic cardiopulmonary bypass (CPB).

Thoracic epidural catheter insertion using the caudal approach assisted with an electrical nerve stimulator in young children.

Objectives: We evaluated whether thoracic epidural catheter placement using the caudal approach and assisted with an electrical stimulator could be performed in young children.

Methods: Ten young children (1-4 years) who underwent abdominal surgeries were studied. Under general anesthesia without muscle relaxants, caudal catheter placement was performed using an 18-gauge Crawford-type needle and a 20-gauge radiopaque epidural catheter with a stainless-steel stylet.

[Intraoperative coronary spasm in patients without a history of anginal chest pain].

We report three cases of intraoperative coronary spasm that developed during non-cardiac surgical procedures. None of the patients had a history of anginal chest pain. The presumed contributing factors were: 1) suction of the trachea during general anesthesia, 2) hyperventilation and hypotension during induction of general anesthesia, and 3) hyperventilation during neuroanesthesia.

[A case of latex anaphylactoid reaction starting with respiratory symptoms].

We report a case of latex anaphylactoid reaction in a 39-year-old man with aortitis. He was scheduled to undergo stent-graft implantation. When the operation progressed into his abdomen, respiratory symptoms, wheezing and high airway pressure, occurred.

[The effect of intrathecal fentanyl added to hyperbaric bupivacaine for caesarean section].

Background: Management of cesarean section with spinal anesthesia is often accompanied with intraoperative nausea and pain. In a randomized controlled study, we explored the effect of intrathecal fentanyl on the characteristics of subarachnoid block in patients undergoing cesarean section.

Methods: Twenty-four healthy parturients scheduled for elective Cesarean section were allocated to receive either fentanyl 0.

Detection of cerebral hypoperfusion with bispectral index during paediatric cardiac surgery.

Background: The bispectral index (BIS) may indicate changes in cerebral activity when the cerebral circulation is affected by acute hypotension.

Methods: We measured BIS and cerebral haemoglobin saturation (Sr(O(2))) by near-infrared spectroscopy in 10 children undergoing cardiac surgery.

Results: We noted 14 episodes of simultaneous decreases in Sr(O(2)) and BIS during acute hypotension in five children.

[Perioperative management for carotid endoarterectomy with induced mild hypothermia: a case report].

We report perioperative management for carotid endoarterectomy with induced mild hypothermia in a patient with severe stenosis of the bilateral carotid arteries. The patient was a 47 year-old male with familial hyperlipidemia and history of coronary artery bypass surgery. Angiography revealed severe stenotic lesions of the right internal carotid artery (ICA) and total occlusion of the left ICA.

[Marked reduction of life-threatening ventricular tachyarrhythmias in a critically ill patient by intravenous administration of magnesium sulfate].

A 90-year-old man with ischemic heart disease underwent an emergent operation for a ruptured abdominal aortic aneurysm. The patient was brought to the operating room in a state of hypovolemic shock, and developed myocardial ischemia and intractable ventricular arrhythmias during the operation. Intensive cardiopulmonary resuscitation including rapid transfusion, external cardiac massage, electrical defibrillation, and extensive use of cardiovascular drugs restored hemodynamic stability temporarily.

Attenuation of haemodynamic responses to tracheal intubation by the styletscope.

Tracheal intubation often causes a haemodynamic response probably generated by direct laryngoscopy. The StyletScope is a new intubation device that does not require direct laryngoscopy. We prospectively measured haemodynamic changes after tracheal intubation using the StyletScope.

[Evaluation of emergence from total intravenous anesthesia with propofol for long neurosurgery].

In six neurosurgical patients we examined their emergence from more than six hours of total intravenous anesthesia with propofol and fentanyl. The anesthesia was maintained properly with total intravenous anesthesia with propofol and fentanyl without nitrous oxide. We calculated the estimated blood concentration of propofol from the anesthesia record using a three-compartment pharmacokinetic model.

[Efficiency of bispectral index in anesthetic management of a patient with hypothyroidism].

A 72-year-old, female patient with severe hypothyroidism underwent tracheostomy using deltopectral flap. During the anesthetic management, we assessed the hypnotic level using the bispectral index and regulated the dose of general anesthetics to maintain the bispectral index at about 50. The general anesthetics caused a marked cardiovascular depression, but the condition was treatable with the intravenous administration of dopamine.

[Anesthetic management for MIDCAB using the target controlled infusion and the bispectral index].

We report our experience in using the target controlled infusion (TCI) of propofol combined with the bispectral index (BIS) monitoring for anesthetic management of minimally invasive direct coronary artery bypass (MIDCAB) in a 43-year-old-male patient with angina pectoris. After premedication, the patient was connected to the monitor with electrodes for BIS monitor. Then, anesthesia was induced with fentanyl and propofol using TCI technique.