Perioperative management for nephrectomy using combined spinal-epidural anesthesia with sedation in a patient with cerebral palsy under maintenance hemodialysis
A 43-year-old man (166 cm, 53.5 kg) with cerebral palsy on maintenance hemodialysis underwent a right nephrectomy for gross hematuria under combined spinal-epidural anesthesia (CSEA) with sedation. The patient suffered from hemiplegia, speech disturbance and low intelligence (approximately 6 years and 8 months). Following premedication with midazolam 4 mg, he was calm and cooperative. An analgesic level below T 10 was obtained by spinal (L 4-5) anesthesia using plain 0.5\% bupivacaine 4 ml. Further cephalad spread (below T 3) was secured by bolus (7 ml) and continuous (8.5 ml.h-1) administration of 2\% mepivacaine for thoracic epidural (T 10-11) anesthesia. Intravenous sedation (midazolam 0.08 mg.kg-1.h-1 and pentazocine 0.24 mg.kg-1.h-1) with 2 l.min-1 oxygen via nasal cannula was given during surgery. The operation and anesthesia times were 216 min and 330 min, respectively. Intraoperative bleeding was 1,158 g and the extracted kidney weighted 2,333 g. Following a prompt recovery with exclamation at the end of surgery, a bolus dose of epidural buprenorphine 0.2 mg combined with droperidol 2.5 mg was administered. Three hours after surgery, sleep was induced by brotizolam 0.25 mg orally. We accomplished a giant nephrectomy under CSEA with sedation in a patient with cerebral palsy receiving hemodialysis. Sufficient premedication using midazolam was profitable for CSEA in mental-retarded patient.
%0 Journal Article
%1 Tabuchi2002
%A Tabuchi, Yachiyo
%A Takamitsu, Yoshihiro
%D 2002
%J Masui
%K Adult; Anesthesia, Epidural; Spinal; Cerebral Palsy; Humans; Male; Nephrectomy; Perioperative Care; Preanesthetic Medication; Renal Dialysis
%N 11
%P 1268--1271
%T Perioperative management for nephrectomy using combined spinal-epidural anesthesia with sedation in a patient with cerebral palsy under maintenance hemodialysis
%V 51
%X A 43-year-old man (166 cm, 53.5 kg) with cerebral palsy on maintenance hemodialysis underwent a right nephrectomy for gross hematuria under combined spinal-epidural anesthesia (CSEA) with sedation. The patient suffered from hemiplegia, speech disturbance and low intelligence (approximately 6 years and 8 months). Following premedication with midazolam 4 mg, he was calm and cooperative. An analgesic level below T 10 was obtained by spinal (L 4-5) anesthesia using plain 0.5\% bupivacaine 4 ml. Further cephalad spread (below T 3) was secured by bolus (7 ml) and continuous (8.5 ml.h-1) administration of 2\% mepivacaine for thoracic epidural (T 10-11) anesthesia. Intravenous sedation (midazolam 0.08 mg.kg-1.h-1 and pentazocine 0.24 mg.kg-1.h-1) with 2 l.min-1 oxygen via nasal cannula was given during surgery. The operation and anesthesia times were 216 min and 330 min, respectively. Intraoperative bleeding was 1,158 g and the extracted kidney weighted 2,333 g. Following a prompt recovery with exclamation at the end of surgery, a bolus dose of epidural buprenorphine 0.2 mg combined with droperidol 2.5 mg was administered. Three hours after surgery, sleep was induced by brotizolam 0.25 mg orally. We accomplished a giant nephrectomy under CSEA with sedation in a patient with cerebral palsy receiving hemodialysis. Sufficient premedication using midazolam was profitable for CSEA in mental-retarded patient.
@article{Tabuchi2002,
abstract = {A 43-year-old man (166 cm, 53.5 kg) with cerebral palsy on maintenance hemodialysis underwent a right nephrectomy for gross hematuria under combined spinal-epidural anesthesia (CSEA) with sedation. The patient suffered from hemiplegia, speech disturbance and low intelligence (approximately 6 years and 8 months). Following premedication with midazolam 4 mg, he was calm and cooperative. An analgesic level below T 10 was obtained by spinal (L 4-5) anesthesia using plain 0.5\% bupivacaine 4 ml. Further cephalad spread (below T 3) was secured by bolus (7 ml) and continuous (8.5 ml.h-1) administration of 2\% mepivacaine for thoracic epidural (T 10-11) anesthesia. Intravenous sedation (midazolam 0.08 mg.kg-1.h-1 and pentazocine 0.24 mg.kg-1.h-1) with 2 l.min-1 oxygen via nasal cannula was given during surgery. The operation and anesthesia times were 216 min and 330 min, respectively. Intraoperative bleeding was 1,158 g and the extracted kidney weighted 2,333 g. Following a prompt recovery with exclamation at the end of surgery, a bolus dose of epidural buprenorphine 0.2 mg combined with droperidol 2.5 mg was administered. Three hours after surgery, sleep was induced by brotizolam 0.25 mg orally. We accomplished a giant nephrectomy under CSEA with sedation in a patient with cerebral palsy receiving hemodialysis. Sufficient premedication using midazolam was profitable for CSEA in mental-retarded patient.},
added-at = {2014-07-19T21:37:32.000+0200},
author = {Tabuchi, Yachiyo and Takamitsu, Yoshihiro},
biburl = {https://www.bibsonomy.org/bibtex/25f6639b4953bd1a7c1e1f29297f93f3a/ar0berts},
groups = {public},
interhash = {73da1afd8ec462fdacdee9e5554177cc},
intrahash = {5f6639b4953bd1a7c1e1f29297f93f3a},
journal = {Masui},
keywords = {Adult; Anesthesia, Epidural; Spinal; Cerebral Palsy; Humans; Male; Nephrectomy; Perioperative Care; Preanesthetic Medication; Renal Dialysis},
month = Nov,
number = 11,
pages = {1268--1271},
pmid = {12481458},
timestamp = {2014-07-19T21:37:32.000+0200},
title = {[Perioperative management for nephrectomy using combined spinal-epidural anesthesia with sedation in a patient with cerebral palsy under maintenance hemodialysis]},
username = {ar0berts},
volume = 51,
year = 2002
}