Spontaneous recovery of paraplegia caused by spinal epidural hematoma after removal of epidural catheter.

We report a patient who developed paraplegia caused by a spinal epidural hematoma after removal of an epidural catheter, which resolved spontaneously. A 60-year-old woman underwent thoracoscopic partial resection of the left lung under general anesthesia combined with epidural anesthesia. She neither was coagulopathic nor had received anticoagulants.

Restoration of Train-of-Four Ratio with Neostigmine After Insufficient Recovery with Sugammadex in a Patient with Myasthenia Gravis.

We present a patient with myasthenia gravis in whom sugammadex failed to restore the train-of-four ratio (TOFR) sufficiently. When the patient's TOFR count had recovered to 2, we administered 2 mg/kg of sugammadex. However, the TOFR did not recover to the preoperative value.

[Hypoxia after cesarean section in a patient with myotonic dystrophy].

A 28-year-old woman, 35 week-pregnant, underwent emergency cesarean section. Although she had no apparent symptoms before the operation, myotonic dystrophy was suspected from physical examination and laboratory data. The anesthesiologist in charge recognized only high creatine kinase.

[Reversal of rocuronium induced neuromuscular block with sugammadex in a patient with myasthenia gravis].

We report a patient with myasthenia gravis whose rocuronium induced neuromuscular block was reversed with sugammadex. A 26-year-old man, 175 cm and 76 kg, with myasthenia gravis, was scheduled for extended thymectomy under general anesthesia. An epidural catheter was inserted at the T5-6 interspace before induction of general anesthesia.

[Cardiac asystole in the postanesthetic care unit: a case report].

We report a patient without apparent heart disease who developed asystole postoperatively. A 24-year-old woman was scheduled for acetabulectomy under lumbar epidural anesthesia with intravenous propofol infusion. There was no profound hypotension or arrhythmia during anesthesia and surgery.

[Anesthetic management of total hysterectomy in a patient with pulmonary thromboembolism].

We report anesthetic management of a 38-year-old woman with pulmonary thromboembolism for total hysterectomy. She had been taking oral contraceptives for adenomyosis of the uterus. She had thrombi in the arteries from pulmonary trunk to bilateral main pulmonary arteries.

[Hypoxemia caused by retention of irrigation fluid to detect leaks from the lungs during subtotal esophagectomy].

We report a patient who developed hypoxemia caused by retention of irrigation fluid used to detect leaks from the lungs during subtotal esophagectomy. A 58-year-old man developed a sudden onset of hypoxemia with a decrease in tidal volume during subtotal esophagectomy. Chest X-ray revealed a homogeneous opacity of the left lung field, suggesting the presence of fluid in the pleural cavity on the left.

Recovery of train-of-four ratio to 0.70 and 0.90 is delayed in type 2 diabetes with vecuronium-induced neuromuscular block.

Context: The recovery profile of train-of-four ratio to more than 0.70 in patients with diabetes mellitus has not been well investigated.

Objective: Our primary objective was to evaluate the spontaneous recovery profile of neuromuscular block by vecuronium until train-of-four ratio more than 0.

[Unilateral temporary meralgia paresthetica after caesarean section: report of a case].

We report a patient who developed unilateral temporary meralgia paresthetica after caesarean section. A 28-year-old morbidly obese woman underwent caesarean section under combined spinal and epidural anesthesia. Intraoperative position was 5-degree head down lithotomy position.

[Surgical treatment of acute cholecystitis].

Fundamental treatment for acute cholecystitis is cholecystectomy. However, the adoption of a treatment is dependend on degree of a severity of acute cholecystitis in each patient because its degree is influenced by factors such as duration from the onset of symptoms to medical examination. Early laparoscopic cholecystectomy is the preferred procedure for mild acute cholecystitis.

[Management of drugs used by anesthesiologists in the operating room].

We report the results of reviews by pharmacists of clerical errors in drugs used in the operating room by anesthesiologists from August 2005 to March 2007 at Fukuoka University Hospital. During the period, 9907 surgical patients were managed by anesthesiologists. There were 4868 clerical errors by anesthesiologists.

[Atelectasis after induction of general anesthesia in an infant with cleft palate].

We report an infant with cleft palate who developed atelectasis as a result of aspiration of food residue after induction of general anesthesia. A 12-month-old girl with cleft palate was scheduled for palatoplasty. The trachea was intubated after 6.

[Rhabdomyolysis after prolonged surgery in lateral decubitus position].

We report an obese patient who developed rhabdomyolysis after prolonged surgery in lateral decubitus position. A 55-year-old woman, with a body mass index of 29.3 kg x m(-2), underwent removal of an acoustic neurinoma in lateral decubitus position which lasted 20 hours.

[Postherpetic neuralgia].

Varicella-zoster virus (VZV) causes two clinically distinct diseases: varicella and herpes zoster. Herpes zoster, recurrent infection of VZV occurs when the cell-mediated immunity to VZV declines. Since the cell-medicated immunity to VZV declines with aging, herpes zoster occurs more frequently in the elderly.

[Postoperative contralateral brachial plexus palsy after prolonged operation in lateral decubitus position].

We report a patient who developed postoperative contralateral brachial plexus palsy after prolonged surgery in lateral decubitus position. A 58-year-old man underwent hepatectomy because of metastatic liver tumor in left decubitus position. The surgical table was rotated anteriorly at 15 degrees.

[Spontaneous spinal subdural and epidural haematoma in a pregnant patient].

We report a pregnant woman who developed non-traumatic spinal subdural and epidural hematoma. A 31-year-old woman at 28 weeks of gestation developed progressive ascending paralysis. MRI suggested the presence of spinal subdural hematoma at T4-6 and spinal epidural hematoma at T4-9.

[Landmark method and ultrasound-guided method of internal jugular vein puncture: comparison of residents with staffs].

Background: We compared landmark with ultrasound-guided methods of internal jugular vein puncture in residents and staffs.

Methods: Seven residents and five staffs practiced internal jugular vein puncture with landmark and ultrasound-guided methods on a manikin for internal jugular vein cannulation. Thereafter, they performed internal jugular vein cannulation on 42 patients.

[Intraoperative ventricular or supraventricular tachycardia? A case report].

A 68-year-old man with a history of paroxysmal supraventricular tachycardia developed wide QRS complex tachycardia one minute after induction of general anesthesia. As the wide QRS complex tachycardia appeared to be ventricular and pulsation of the radial artery could not be felt, intravenous antiarrhythmic drugs were given. Surgery was postponed.

[Complications of internal jugular vein cannulation under ultrasound guidance: report of three].

Internal jugular cannulation with ultrasound guidance has been advocated to decrease its complications. However, there can be serious complications by in-experienced physicians in even ultrasound-guided internal jugular vein cannulation. We report three cases of complications associated with ultrasound-guided internal jugular vein cannulation: puncture of the common carotid artery in two patients and pneumothorax in one.

[Monitoring of muscle relaxation at the corrugator supercilli muscle in a patient with atrophied upper limbs].

We report a patient whose muscle relaxation was monitored at the corrugator supercilli muscle. In a 51-year-old woman with markedly atrophied upper limbs, anesthesia was induced with propofol and fentanyl. Muscle relaxation was monitored at the adductor pollicis and corrugator supercilli muscles with accelomyography.

[Training of internal jugular vein cannulation: comparison of landmark method with ultrasound-guided method].

We compared training of internal jugular vein cannulation with ultrasound-guided method and that with landmark method in a group of 10 residents and that of 10 staffs. Cannulation was increasingly successful with both methods as the training proceeded, and with increasingly less time and fewer number of punctures. There was no statistically significant difference in time or in number of punctures with ultrasound-guided method between the groups.

[Neuromuscular monitoring].

In patients receiving a neuromuscular blocking agent, quantitative monitoring of neuromuscular function is essential. For this purpose, neuromuscular monitoring devices which provide train-of-four ratio values are necessary In the absence of a quantitative monitoring device, neuromuscular function may be evaluated with the use of a nerve stimulator. Muscle responses can be monitored either using the mechanomyography, electromyography, acceleromyography, or phonomyography.

[Postoperative profound hypoglycemia after resection of adrenaline-predominant pheochromocytoma].

A 54-year-old woman was scheduled for resection of pheochromocytoma. Anesthesia was maintained with general anesthesia combined with thoracic epidural anesthesia. The blood glucose decreased to 30 mg x dl(-1) about four hours after the tumor resection, despite intravenous administration of glucose at a rate of 15 g x hr(-1) with intermittent boluses of 5 g of glucose.