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PubMed2001

[Anesthesia for a patient with alcoholic heart disease and transient complete heart block].

A 70-year-old man who had been drinking a bottle of whisky each day was scheduled for laser resection of a tongue tumor. His electrocardiogram showed sinus bradycardia (heart rate was 35-40 bpm), and transient complete heart block was observed. Echocardiography showed hypertrophic cardiomyopathy. After a temporary transvenous pacemaker had been inserted, anesthesia was induced with thiopental and vecuronium bromide, and maintained with sevoflurane and fentanyl. Heart rate was 45.min-1 before the induction of anesthesia, and after the induction increased to 70-80.min-1. Analysis of heart rate variability suggested that the increase in heart rate was due to augmentation of sympathetic nervous activity after intubation and operation stress. After the operation his bradycardia improved gradually, and after 3 months heart rate settled at about 55.min-1. Cadiomyopathy is known to be one of the complications of alcoholism. It was reported that alcoholic heart disease was improved promptly by abstinence from alcohol. During his long hospitalization, abstinence might have improved his severe bradycardia. Thiopental is useful for induction of anesthesia in a patient with severe bradycardia from alcoholic cadiomyopathy.

Aged↗

PubMed2002

[Difficult airway management in a patient with history of tracheotomy].

A 12-year-old girl was scheduled to undergo tympanoplasty. She had received tracheotomy at the age of 10 months. As preoperative bronchofiberscope could reach the glottis with no difficulty, we chose rapid induction. Suddenly after the administration of thiopental, fentanyl and vecuronium bromide, we could not keep mask ventilation. As sniffing position and insertion of airway could not improve difficult ventilation, we intubated quickly. The intubation was easy. We consider that difficult ventilation was not due to upper airway trouble but due to tracheotomy. Muscles around the granuloma were relaxed, and the trachea was closed, just at the height of tracheotomy. We conclude that it may sometimes be difficult in a child with history of tracheotomy to keep mask ventilation.

Adolescent↗

PubMed2002

Transesophageal atrial pacing in the management of re-entry supraventricular tachyarrhythmias occurring during general anesthesia.

BACKGROUND: Supraventricular tachyarrhythmias (SVTs) represent an intraoperative risk factor that should be always prevented/managed. The commonly used anti-arrhythmic drugs are accompanied by intrinsic hazards, such as pro-arrhythmic and toxic effects or unpredictable onset and duration of action. We underline the therapeutic use of transesophageal atrial pacing (TAP) for the interruption of particular re-entry SVTs occurred during surgical procedures in general anaesthesia. METHODS: Our study was carried out in 25 patients characterized by a personal clinical history of transient tachyarrhythmic episodes, subjected to general anaesthesia obtained by midazolam, propofol, N2O e O2, sevoflurane, fentanil and vecuronium bromide. We used TAP bursts of 3-5 sec, their minimal pacing rate being equivalent to the tachyarrhythmia cycle length, with an impulse intensity ranging from 18 to 25 mA. In such conditions, the re-entry was interrupted by the induction of refractoriness of the wave-front that sustained the underlying arrhythmogenic circuit. RESULTS: During the study, the following arrhythmias occurred in 7 out of all patients: 1 type I atrial flutter, 3 nodal tachycardias, 1 antidromic and 2 orthodromic atrioventricular tachycardias, respectively. TAP assured either atrial capture or prompt suppression of arrhythmias in all cases. Low intensity impulses did not ever allow ventricular capture. CONCLUSIONS: TAP can be considered as a valid therapeutic device for the management of re-entry SVTs occurred during general anaesthesia, resulting it effective, safe and easy-practicable.

Anesthesia, General↗

PubMedDate not supplied

A comparison of intravenous ketoprofen versus pethidine on peri-operative analgesia and post-operative nausea and vomiting in paediatric vitreoretinal surgery.

AIM: To compare the efficacy of ketoprofen and pethidine for peri-operative analgesia and post-operative nausea and vomiting in children undergoing vitreoretinal surgery and surgery for retinal detachment. MATERIAL AND METHODS: Children aged 7 to 16 years and ASA I status, undergoing vitreo-retinal surgery were randomly allocated to receive either ketoprofen 2mg/kg or pethidine 1mg/kg intravenously for peri-operative analgesia. In all patients, general anaesthesia was induced with thiopentone and intubation was facilitated with vecuronium bromide and maintained with 33% oxygen in nitrous oxide and isoflurane. Intra-operative and post-operative monitoring was done by an observer blinded to the technique. Intra-operative rescue analgesia was used if heart rate and/or blood pressure increased by 25% from pre-incision values. Post-operative pain and episodes of nausea and vomiting were evaluated at recovery (0 hour), 2, 6 and 24 hours intervals. Standard rescue analgesia and anti-emetic agents were administered if required. RESULTS: Eighty-six children were enrolled in the study. Forty-four received ketoprofen while 42 received pethidine. Intra-operative analgesia was comparable in both the groups and no significant difference was found in the requirement of intra-operative rescue analgesia, as well. Postoperatively 6/44 (13.6%) children in ketoprofen group had pain at recovery compared to 17/42 (40.4%) in pethidine group. Pain at 2, 6 and 24 hours, and postoperative analgesic requirement were not significantly different among the two groups. Post-operative nausea, vomiting, and antiemetic requirement were significantly less in the ketoprofen group at all time intervals. CONCLUSION: Ketoprofen is a satisfactory alternative analgesic to pethidine for vitreoretinal surgery and results in a lower incidence of postoperative nausea and vomiting.

Adolescent↗

PubMed2004

[Total intravenous anesthesia with propofol, ketamine, and fentanyl (PFK) for a patient with mitochondrial myopathy].

Anesthetic management for a patient with mitochondrial myopathy is described. A 57 year-old-female underwent laparoscopic cholecystectomy for cholelithiasis. The patient had been diagnosed as having mitochondrial myopathy from muscle biopsy. Anesthesia was managed with total intravenous anesthesia with propofol, fentanyl, and ketamine. Her reaction to vecuronium bromide was within normal limits evaluated with a neuromuscular activity parameter, train-of-four ratio. No serious acidosis, hyperlactemia, hypothermia, nor prolonged recovery from the anesthesia was observed. As inhaled anesthetics may be contraindicated for mitochondrial myopathy, and nitrous oxide for laparoscopic surgery is relative contraindication, total intravenous anesthesia with muscle relaxant titration is appropriate for laparoscopic surgery for patients with mitochondrial myopathy.

Anesthesia, Intravenous↗

PubMed2004

[Effect of respiratory care on pulmonary function in patients after cardiopulmonary bypass].

BACKGROUND: Respiratory failure after cardiopulmonary bypass (CPB) remains one of the major complications after cardiac surgery. This study was designed to evaluate effects of respiratory care after CPB on pulmonary function. METHODS: Eighteen patients scheduled for cardiac surgery were investigated. Preoperative respiratory functions (%VC, FEV1.0%, V25/Ht, FRC-CC, deltaN2) were measured in all the patients. Both induction and maintenance of anesthesia were performed using propofol, midazolam, fentanyl, and vecuronium bromide. All the patients were ventilated using volume controlled ventilation by setting FIO2 at 0.5, the respiratory frequency at 15 x min(-1), the tidal volume at 6-10 ml x kg(-1) adjusted to maintain PaCO2 between 30 to 40 mmHg, and the peak airway pressures below 40 cmH2O, PEEP of 0 cmH2O. From 1 hour after the operation, the patients were randomly divided into 2 groups: group A, ventilated artificially with PEEP of 5 cmH2O and group B, ventilated with PEEP adjusted to the patient's lower inflection point (LIP) obtained by the pressure-volume curve. PaO2, Qs/Qt and FRC were measured after induction of anesthesia, just after surgery, 1 hour after surgery and 1 hour after artificial ventilation with PEEP. The values of the LIP were obtained from the P-V curves with the constant-flow methods before and after surgery. RESULTS: PaO2 and FRC decreased and Qs/Qt increased significantly after the surgery in all the patients. One hour after artificial ventilation with PEEP, PaO2 increased and Qs/Qt decreased significantly compared with the values after operation. However, there was no significant difference in the magnitude of these changes among the different groups. The changes in PaO2 and Qs/Qt were not correlated with the changes in FRC and preoperative respiratory functions. The LIP tended to increase after surgery in 2 groups. CONCLUSIONS: Although pulmonary function deteriorated after CPB. PEEP could improve oxygenation in all the patients. There were no significant differences in the degree of these improvements between patients receiving PEEP of 5 cmH2O and patients with PEEP adjusted to their LIP. There was no significant relationship between preoperative pulmonary function and changes in oxygenation after CPB.

Adult↗

PubMed2004

[A case report of severe laryngeal edema which occured before removal of a laryngeal mask airway].

A 41-year-old woman was scheduled for a partial hip arthroplasty. She was suffering from malignant rheumatoid arthritis for a long time and we recognized her difficult airway. After epidural catheterization, anesthesia was induced with fentanyl, thiopental, and 5% sevoflurane with oxygen. A laryngeal mask airway (LMA ; size 3) was inserted smoothly on third trial after suxamethonium chloride administration. Anesthesia was maintained with fentanyl, vecuronium bromide, sevoflurane with oxygen and epidural anesthesia. No complications were observed during the operation. After reversal of muscle relaxant, spontaneous respiration returned. But inspiratory stridor and chest wall retraction occurred soon, and we found severe epiglottic edema by bronchoscopy. A tracheal tube (ID 5.5 mm) was intubated immediately through the LMA. Twenty hours later the pharyngeal edema was still very severe, and tracheotomy was performed. The edema disappeared three days later. We thought the edema had occurred as a result of blood flow disturbance caused by LMA in narrow pharyngeal space expanding to the epiglottis. It should be kept in mind that severe edema could develop after LMA in malignant rheumatoid arthritis.

Arthritis, Rheumatoid↗

PubMed1992

[The effect of halothane, alfentanil and propofol on blood flow velocity, blood vessel cross section and blood volume flow in the middle cerebral artery].

Transcranial Doppler sonography (TCD) has gained in relevance for noninvasive monitoring of the cerebral circulation during the perioperative period. As long as the diameters of the investigated vessels remain unknown, however, flow velocities alone are not really informative. Exact vessel diameter determination in humans under the influence of different anesthetic drugs has not yet been performed due to ethical and methodological restrictions. A new modification of TCD allows analysis of the reflected "Doppler power", which is proportional to the cross-sectional area of the insonated vessel. METHODS. Three groups of 15-16 patients each (ASA I) were investigated after informed consent. Anesthesia was induced with droperidol, alfentanil, thiopental, and vecuronium bromide. After intubation patients were normoventilated with N2O:O2 = 3:2 and additional doses of alfentanil were injected until the transcranial ultrasound probe was fixed to the temporal bone and focused on the middle cerebral artery. Baseline values of heart rate (HR), mean arterial pressure (MAP), expiratory minute volume (EMV), end-expiratory CO2 (FeCO2), and TCD were measured. Then 1.5 vol% halothane, 25-50 micrograms/kg alfentanil, or propofol (1.5 mg/kg iv., 10 mg/kg.min) was administered. Further measurements (HR, MAP, EMV, FeCO2 and TCD) were performed at 3, 6, 10, and 20 min after the start in the halothane and propofol groups and after 3 and 6 min in the alfentanil group. The following transcranial parameters were derived from the TCD device: mean maximal flow velocity (vmmax), pulsatility index, time-averaged mean velocity (vmmen), "vessel area (VA)", and "volume flow (VF)". The mean +/- standard deviation of each parameter was calculated. Statistical evaluation was performed by paired t-tests (level of significance P less than 0.05). RESULTS. HR showed a tendency to increase after halothane and to decline after alfentanil. Alfentanil induced a short-term decline in MAP. End-expiratory minute volume and FeCO2 showed only minor alterations in all three groups. The vmmax was nearly doubled by halothane. Alfentanil induced a transitory decline in vmmax while Propofol decreased it markedly. The pulsatility index showed a decrease after halothane; alfentanil caused a short-term increase. Propofol induced a strong increase after 3 min; in the following period a return to baseline values was observed. The vmmean was increased by halothane and reduced by 32% propofol. VA was found to be unaltered by alfentanil and propofol but was more than doubled by halothane. Accordingly, the relative value for VF increased by 148% under halothane. VF appeared to decline after propofol. DISCUSSION. The described method allows only the determination of relative values: it is not possible to quantify exactly how much the VA changed. Halothane caused significant increases of VA measured in the middle cerebral artery, whereas alfentanil and propofol did not influence this parameter. This is in accordance with previous experiments in dogs in which halothane decreased the resistance of large basal cerebral arteries (LAR). LAR remained unaltered after alfentanil administration. The site of action of some anesthetic agents on cerebral vessels does not seem to be restricted to cerebral arterioles: at least for halothane, a vasodilating effect on large cerebral arteries could be demonstrated. This should be kept in mind when transcranial Doppler is applied during the perioperative period.

Alfentanil↗

PubMed1992

[Effects of endotracheal intubation on the trachea--usefulness of the evaluation by MRI].

Using an MRI apparatus, we observed the effects of endotracheal intubation on the trachea by measuring T1 value before and after an operation in ten surgical cases. T1 value of the anterior wall at the level of the first tracheal ring was 275.8 +/- 58 msec, and that of the posterior wall was 346.8 +/- 72 msec. The patients were all intubated under general anesthesia. Anesthesia was maintained with inhalation anesthesia such as nitrous oxide-oxygen-enflurane with the aid of vecuronium bromide. Periods of intubation varied between 80 to 46 minutes, and averaged 270 +/- 112 minutes. After the extubation, T1 value showed 312 +/- 62 msec at the anterior wall and 395 +/- 82 msec at the posterior wall. In the case of the posterior wall, T1 value was significantly prolonged compared with that of the pre-intubation period. Prolongation of T1 value is assumed to be related to the increase of tissue free water demonstrating the occurrence of tissue edema. From the findings that T1 value might be prolonged by endotracheal intubation, we conclude that the MRI apparatus is useful for investigating the effects of the intubation procedure on the trachea.

Adult↗

PubMed2005

[Changes in oxygen metabolism in hepatitis B gravis in peri-operative stages of orthotopic liver transplantation].

OBJECTIVE: To investigate the changes in oxygen metabolism in peri-operative stages in hepatitis B gravis and non-hepatitis B gravis undergoing orthotopic liver transplantation (OLT). METHODS: Twelve patients undergoing OLT for hepatitis B gravis (experimental group) and 10 patients without hepatitis B gravis (control group) were enrolled for study. Anesthesia was induced by propofol, fentanyl and vecuronium bromide, and maintained with isoflurane. Arterial catheter was inserted into the left radial artery. Swan-Ganz catheter was inserted through the right internal jugular vein. Arterial partial pressure of oxygen (PaO(2)), mixed venous partial pressure of oxygen (PvO(2)), arterial oxygen content (CaO(2)), mixed venous oxygen content (CvO(2)), arterial-venous oxygen content difference (Ca-vO(2)), oxygen delivery (DO(2)), index of oxygen delivery (DO(2)I), oxygen consumption (VO(2)), index of oxygen consumption (VO(2)I), index of oxygen extract (O(2)EI), oxygen extract rate (O(2)ER) were determined before skin incision (T1), 10 minutes before anhepatic phase (T2), 25 minutes after liver was removed (anhepatic phase, T3), 30 minutes in neohapitic phase (T4), and the end of operation (T5). RESULTS: (1) In the experimental group, PvO(2) increased, Ca-vO(2) decreased, DO(2) and VO(2) showed no change, and O(2)EI and O(2)ER decreased in T2. In preanhepatic period, PvO(2) increased, Ca-vO(2) decreased, DO(2) and VO(2) did not change. In anhepatic period, DO(2), DO(2)I, VO(2) and VO(2)I decreased obviously, DO(2) decreased by 43%, while VO(2) decreased by 21%, and O(2)ER increased obviously. In reperfusion period, PaO(2) and PvO(2) increased, CaO(2) and Ca-vO(2) decreased, DO(2) and DO(2)I increased, VO(2) and VO(2)I recovered to base level. After termination of operation, PvO(2), DO(2), DO(2)I were still high. (2) In the control group: PvO(2) increased, O(2)EI and O(2)ER decreased, but no significant changes were found in DO(2) and VO(2) in T2. DO(2), DO(2)I, VO(2), and VO(2)I all decreased in T3, while DO(2) reduced by 25% and VO(2) reduced by 12%. In T4, PvO(2), DO(2) and DO(2)I all increased, while Ca-vO(2), VO(2) and VO(2)I reached the pre-operative levels in T4. DO(2) and DO(2)I levels were higher than those of pre-operation in T5. CONCLUSION: The decrease in DO(2) is more obvious than VO(2) in anhepatic period during OLT in hepatitis B gravis patients. In neohepatic period, DO(2) increases while VO(2) returns to base level.

Adult↗

PubMed1991

[Anesthetic management of a patient with Sipple syndrome].

Resection of bilateral pheochromocytomas of a 33-year-old man with Sipple syndrome was scheduled. Oral prazosin was started twenty days before the operation and increased to a maintenance dose of 6 mg per day. Oral lavetalol 300 mg per day was added for five days before the operation because prazosin alone was insufficient. Intravascular volume was expanded with two units of stored whole blood per day for four days before the operation for preoperative preparation. Anesthesia was induced with thiamylal 250 mg and vecuronium bromide 9 mg, and maintained with enflurane, nitrous oxide and oxygen. Phentolamine, labetalol and nitroglycerin were used for treatment of hypertensive crises during operation and anesthesia. To combat hypotension which follows the resection of the tumor, continuous infusion of norepinephrine was used for four hours after the operation. There were no hypotensive periods and no complications. After removing bilateral pheochromocytomas of the adrenals, treatment of full adrenocortical replacement therapy was performed. Concurrent use of alpha-and beta-adrenergic blocking agents was important for successful anesthetic management for the resection of pheochromocytoma.

Administration, Oral↗

PubMed1991

[The use of propofol in combination with fentanyl or buprenorphine in long-duration anesthesia].

Fifty patients of both sexes, aged between 37 and 60 years old and belonging to ASA classes I, II, III and IV, underwent urological surgery lasting more than two hours under general anesthesia using a continuous infusion of propofol, N2O/O2, vecuronium bromide 0.02% infusion. Patients were divided into two groups of 25, group A and group B, according to whether they received fentanyl or buprenorphine as an analgesic. Propofol and fentanyl consumption in group A were 5.43 +/- 0.7 mg/kg/hour and 10.53 +/- 1.7 micrograms/kg respectively, whereas those of propofol and buprenorphine in group B were 5.71 +/- 1.08 mg/kg/hour and 6.05 +/- 0.06 micrograms/kg; there was a statistically non-significant difference for propofol consumption (p greater than 0.005). During the induction and maintenance phases of anesthesia, hemodynamic parameters decreased significantly (p less than 0.001) in comparison to starting values in both groups, but no statistically significant differences were observed. Buprenorphine prolonged reawakening from anesthesia by a few minutes but at the same time extended postoperative analgesia by several hours, thus improving the overall quality of the immediate postoperative period. The most frequent side effect (32% in group A and 52% in group B) was sinusal bradycardia.

Adult↗

PubMed1990

[Impairment of neuromuscular transmission in fatigued canine diaphragm].

The role of impairment of neuromuscular transmission in fatigued canine diaphragm was investigated by comparing the function of fatigued diaphragm with that of neuromuscular junction (NMJ)-blocked diaphragm. Diaphragmatic fatigue was produced by intermittent supramaximal stimulation of bilateral phrenic nerves. Partial NMJ blockade was obtained by vecuronium bromide administered intravenously. During control study, no fade was observed either in integrated diaphragmatic electric activity (Edi) or transdiaphragmatic pressure (Pdi). In fatigued diaphragm, Edi generated by 100 Hz showed a remarkable fade. The fade was prominent in high frequency fatigue. In NMJ-blocked diaphragm, fade was observed in Pdi as well as in Edi produced by 100 Hz. The fade of Edi by 100 Hz was prominent. In low frequency fatigue, both Pdi and Edi produced by 20 Hz test stimulation were significantly lower than control values. These results show that in addition to impairment of excitation-contraction coupling, neuromuscular blockade is involved, at least in part, in low frequency diaphragmatic fatigue.

Animals↗

PubMed1990

[Bronchoscopy in ventilated patients: full narcosis or local anesthesia?].

In a prospective, randomised trial bronchoscopy was performed either in local anaesthesia (LA) or general anaesthesia, each on 15 ventilated patients. LA was carried out with oxybuprocain-hydrochloride 1% in repeated doses injected into the trachea and main bronchi, general anaesthesia with midazolam, piritramide and vecuronium bromide. Measurements were performed before, 3 minutes after induction of anaesthesia, immediately after bronchoscopy and 15 and 60 minutes after bronchoscopy. There was no effect on cardiocirculatory function during bronchoscopy in both groups, but we found a decrease in paO2 from 97 to 80 mmHg (median) after application of LA. Subsequent bronchoscopy did not significantly influence paO2. The present study shows that in ventilation patients undergoing fibreoptic bronchoscopy, the application of LA will usually result in a decline of arterial oxygen tension. This procedure should therefore only be performed if general anaesthesia is undesirable, as e.g. in patients being weaned from ventilation.

Adolescent↗

PubMed1990

[Anesthesia using propofol during surgery of strabismus in children. A comparison of two different protocols of induction and maintenance].

The purpose of this study is an investigation of two protocols using propofol as induction and maintenance agent in 100 children scheduled for strabismus surgery (4-8 year, ASA I, NYHA I). Protocol I; Propofol 6 mg.kg-1 in 60 s with fentanyl 2 micrograms.kg-1 and vecuronium bromide 0.08 mg.kg-1 for induction, followed by propofol 11 mg.kg-1 for maintenance; Protocol II; Propofol 3 mg.kg-1 in 20 s with fentanyl 3 micrograms.kg-1 for induction, followed by propofol 12 mg.kg-1.h-1 for maintenance. It appears that the use of protocol I offers significant advantages compared with protocol II: a better quality of induction with a lesser incidence of pain during injection of propofol; a better quality of maintenance with very infrequent bradycardia from oculocardiac reflectivity; and a better recovery with a greatly reduced frequency of nausea and vomiting.

Anesthesia, Intravenous↗

PubMed1986

[Isoflurane in pediatric anesthesia].

Seventy patients 1-10 years of age were submitted to isoflurane (I) or halothane (H) anaesthesia (O2:N2O = 1:3); H was used as a reference substance. Under I anaesthesia, haemodynamic parameters proved to be well preserved. While the pulse rate under I increased significantly, the diastolic pressure decreased as a result of peripheral vascular dilatation. Baroceptor reflexes seemed to function more properly under the effect of I. Spontaneous respiration was definitely depressed by I. Respiratory rate, minute volume, end-expiratory CO2 and pCO2 values indicated CO2 accumulation. Younger children breathing spontaneously were subject to airway problems in I more than in H anaesthesia by decreasing negative occlusion pressures. Increasing doses of vecuronium bromide (5, 10, 15 and 70 micrograms/kg body wt.) accomplished muscular relaxation of various degrees, as tested by the train-of-four (TOF) method. The use of I in two age groups resulted in faster onset, more profound muscular relaxation, and longer duration in comparison with H; these results were statistically significant.

Age Factors↗

PubMed1995

[Adeno-tonsillectomy after cardiac transplantation in a child].

A case report of a boy who had a heart transplant at age one, and an adeno-tonsillectomy at age 2 years and 2 months, is presented. The patient showed severe episodic hypoxemia and poor weight gain (below 3 SD) due to upper airway obstruction caused by enlarged adenoids and tonsils. He was very active and no signs of congestive heart failure were noted. General anesthesia was induced with thiopental and maintained with a balanced anesthesia of nitrous oxide, oxygen, fentanyl, and vecuronium bromide. The heart rate did not increase with endotracheal intubation nor adenoidectomy but heart rate and blood pressure did increase slowly by the time the tonsillectomy was performed. Arrhythmia did not appear throughout the procedure and anesthesia was uneventful. A nasal endotracheal tube was kept in place for 4 days until surgical edema subsided. Respiratory inductive plethysmography performed before surgery and 2 days after extubation showed improvement of upper airway obstruction. The patient's blood concentration of cyclosporine fell briefly below the optimal level perioperatively due to unavailability of intravenous preparation in Japan. Various aspects of non-cardiac anesthesia for children who have experienced cardiac transplants are discussed.

Anesthesia, General↗

PubMed1994

[An emergency operation for a patient in hypercalcemic crisis--a case report].

Hypercalcemic crisis due to hyperparathyroidism which is resistant to medical treatment, is a rare clinical condition which requires prompt surgical intervention. This 78 year-old woman was hospitalized because of hypercalcemic crisis. Conservative treatment including hemodialysis was not successful. A progressive mental disorder was noted. The maximum preoperative calcium value was 18.5 mg.dl-1, and an emergency surgery was scheduled. Anesthetic management for the hypercalcemic state includes (1) good hydration, (2) protection of the cardiac function, and (3) consideration of specific pathological features like renal failure. Balanced anesthesia with analgesics, vecuronium bromide and calcium blocker (diltiazem 0.5 microgram.kg-1.min-1) had been advocated to maintain the stable circulatory state. Postoperatively, this patient went into hypocalcemic seizures and treatment was necessary for a long period of time.

Aged↗