Case Report Severe Bradycardia Possibly due to a Local Anesthetic Oral Mucosal Injection during General Anesthesia

Local anesthesia may induce systemic complications leading to parasympathetic activity leading to bradycardia and hypotension. We report a case of a 50-year-old man undergoing dental surgery under general anesthesia who experienced severe bradycardia and hypotension after local anesthesia infiltration. Concerns regarding the utilization of a relatively large lumen injection needle for local anesthesia during general anesthesia are discussed

中枢性尿崩症患者の全身麻酔経験

The central diabetes insipidus is a disease which causes the parasecretion of antidiuretic hormone through the degeneration of hypothalamus and the posterior-lobe-of-hypophysis system, and makes polyuria, the polyposia, and dipsesis the cardinal symptoms. For this reason, a critical complication may be caused to into the trap from the edema because of the water intoxication by oliguria, a generalized seizure, and the electrolyte imbalance by polyuria. We experienced the general anesthesia management of a patient who has central diabetes insipidus. A 25-year-old male patient (height 168cm, weight 50kg), diagnosed with a left side fracture of the mandible, was scheduled for open reduction pexia under general anesthesia. Anesthesia was induced with propofol and maintained with N_2O, O_2 and sevoflurane. During the operation the patient was kept on controlled ventilation monitoring by percutaneous SpO_2, arterial blood gas analysis, etc., and furthermore, had the central venous pressure meosured as one of the indexes of body fluid management. But the oliguria trend was accepted during the operation. So self-sustaing administration of the prostagrandin E1 and the furosemide of the diuretic of a loop system was prescribed for the patient, because the oliguria has not improved although management through a transfusion load was tried. It is important to take great care of the management of a patient with diabetes insipidus with regard to fluid balance, urine volume and electrolytes management

重度慢性閉塞性肺疾患患者に対して全身麻酔中に投与したアミノフィリンにより心室性期外収縮が発生した一例

Aminophylline, which is a potent and effective bronchodilator, is most useful for the treatment of bronchial spasms in pre- and intraoperative management. But it is well-known that the combination of aminophylline and inhalation often cause a severe ventricular arrhythmia. We reported that we suspected a premature ventricular constraction (PVC) was caused by administering intravenously aminophylline for controlled ventilation of a patient with severe chronic obstructive lung disease during general anesthesia. A 77-year-old male (height 155 cm, weight 54 kg) patient, diagnosed with right maxillary cyst, was scheduled for a right maxillary cyst extirpation under general anesthesia. Anesthesia was induced with thiopental sodium and maintained with N_2O, O_2 and sevoflurane. During the operation the patient was kept on controlled ventilation monitoring by per cutaneous SpO_2, arterial blood gas analysis, etc. without any complications. But it was suspected PVC occurred about five minutes after the intravenous administration of aminophylline given to prevent hypoxemia. It is important to take great care in administering medication, because drug-induced reactions, anesthetic stage and operative invasion may coincide to cause unexpected events

三尖弁閉鎖症を合併した歯科治療患者の鎮静管理経験 : 近赤外線酸素モニターの応用

We experienced intravenous sedation management of a patient who had the tricuspid atresia (TA, 1b) and also investigated the change in intracerebral oxygen environment during intravenous sedation using a near-infrared oxygen monitor (NIRO). A 21-year-old male (height 160cm, weight 61kg) patient, diagnosed with horizontal eruption of wisdom teeth in lower jaw left-hand side, was scheduled for extraction under intravenous sedation. He was diagnosed with tricuspid atresia just after birth. Balloon atrioseptostomy (BAS) was done at 24 days, Blalock-Taussing shunt operation at 4 years old, and Gleen operation at 2 years old. He had cyanosis and clubbed fingers, SPO_2 by pulse oximetry showed 82 to 85% oxygen saturation with room air in everyday life. The ampicillin natrium (2g) was administered 60 minutes before the start of anesthesia intravenously. Intravenous sedation was maintained with 41/min oxygen, midazolam (2.0mg) and propofol (0.6～1.2μg/ml) to relieve anxiety and procedural stress leading to possible changes in his hemodynamic state. His hemodynamics were almost stable. The oxygenation index (TOI) by NIRO was changed 68.8 to 76.2% within normal range and may not have been a clinical problem. Tricuspid atresia is a disease with a poor prognosis. So we have needed a grasp of sick reserve force and careful caution for the complications in anesthetization management. Moreover, it was suggested that NIRO is effective for safe perioperative management in intravenous sedation management

Severe Bradycardia Possibly due to a Local Anesthetic Oral Mucosal Injection during General Anesthesia

Local anesthesia may induce systemic complications leading to parasympathetic activity leading to bradycardia and hypotension. We report a case of a 50-year-old man undergoing dental surgery under general anesthesia who experienced severe bradycardia and hypotension after local anesthesia infiltration. Concerns regarding the utilization of a relatively large lumen injection needle for local anesthesia during general anesthesia are discussed