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We report a case of subarachnoid hemorrhage due to rupture of a cerebral aneurysm in a 29-year-old woman in the 34th week of pregnancy. The aneurysm at the anterior communicating artery was up to 10 mm in diameter on magnetic resonance imaging and scheduled for emergent coil embolization. Simultaneously, obstetricians determined that cesarean section should be performed. Maintaining anesthesia by propofol and remifentanil, coil embolization was first performed to avoid aneurism re-rupture, and the patient was then transferred from an angiography room to an operating room where a cesarean section was performed. After delivery, fentanyl 600 μg was intravenously administered, and the patient was extubated immediately after the operation without any complaints. The neonate (weighing 1,882 g, Apgar score 4 at 1 min and 5 at 5 min) also recovered with no complications after 24 hr artificial ventilation. In conclusion, intravenous anesthesia mainly with remifentanil is adequate for a pregnant patient receiving cesarean section preceded by neurosurgery.

Background: The number of lung transplantation has tended to increase as a treatment for patients with pulmonary arterial hypertension (PAH) and lymphangiomyomatosis (LAM) in Japan. However, we have little evidence about the comparison of perioperative management in patients with PAH and that in patients with LAM., Methods: In this retrospective study, ten patients with PAH and seventeen patients with LAM who underwent the lung transplantations between 2006 and 2011 were enrolled., Results: PAH patients received double lung transplantation with intraoperative cardiopulmonary bypass (CPB) support. Before anesthesia induction, percutaneous cardiopulmonary support (PCPS) was begun. Most of LAM patients received single lung transplantation without using CPB support and PCPS support before anesthesia induction. But sometimes during an operation PCPS support was necessary. Postoperative PCPS support showed no significant differences between PAH and LAM. The four year survival rate was 80% (PAH) and 87.8% (LAM). Pao2/FIo2 in patients with PAH and in those with LAM, %FEV10 in those with LAM after surgery improved when compared to those before surgery., Conclusions: The large difference in perioperative management between patients with PAH and those with LAM is an important knowledge for anesthesist.

Background: Intensive perioperative management is required for adrenalectomy in patients with pheocromocytoma because of the unstable hemodynamics and life threatening cardiovascular disturbances due to catecholamine surge from the neuroendocrine tumors. The aim of this study was to assess the perioperative factors contributing to the hemodynamic changes during surgery in pheochromocytoma., Methods: Ten patients with pheochromocytoma undergoing elective adrenalectomy were enrolled in this retrospective study. The circulating blood volume before surgery and the perioperative factors associated with hemodynamic changes during surgery were assessd by the pulse dye densitometry and VigileoTM/ FroTracTM system, respectively., Results: The decreases of blood pressure after resections of the central veins from tumors were significantly greater in laparotomy than those in laparoscopic surgery (P<0.05). In addition, the decreases of blood pressure after resection of the central were correlated with tumor sizes (R= -0.611), perioperative noradrenaline (NA) blood levels (R= -0.860), perioperative amounts of NA in urine (R= -0.743), and mean stroke volume variations for 5 min after resection of the veins(R= - 0.679)., Conclusions: The decreases of blood pressure after resections of the central veins are dependent on the perioperative blood NA levels, the level of NA in the perioperative urine testig, and tumor sizes.

Recently, rocuronium is being used in patients for caesarean section undergoing general anesthesia instead of suxamethonium. An increased dose of rocuronium improves intubating conditions but prolongs neuromuscular blockade. Sugammadex reverses rapidly and predictably even profound rocuronium-induced neuromuscular blockade. We experienced 13 cases of caesarean section patients undergoing general anesthesia with thiopental (3.5 mg x kg(-1)) and rocuronium (0.9 mg x kg(-1)). At the end of surgery, sugammadex (2 mg x kg(-1)) was administered every 3 minutes repeatedly until TOF>0.9. In two patients, neuromuscular blockade spontaneously recovered to TOF>0.9 at the end of surgery. In most patients administered sugammadex, TOF recovered to more than 0.9 within a few minutes. However, in one patient who had chronic renal failure (creatinine clearance rate: 12 ml x min(-1)), 10 minutes were required for TOF to recover to more than 0.7, and TOF never reached 0.9. All patients were successfully intubated at the first attempt. No signs of recurarization or adverse effects related to sugammadex were noted in the perioperative period.