General anesthetic management with balanced anesthesia in an elderly patient undergoing repeated surgery

Hajime Shimoda, C. Futenma, T. Igari, T. Yasuda, M. Sato, M. Ito, H. Morikawa, T. Teshima, N. Iwatsuki

Research output: Contribution to journalArticlepeer-review


An 89-year-old man (diagnosis: carcinoma of tongue) was operated on under general anesthesia three times in about a year. During the first perioperative course, he received thiamylal sodium intravenously for anesthetic induction, followed by SCC for endotracheal intubation; he was then anesthetized with nitrous oxide 41/min-oxygen 21/min-sevoflurane below 1% in order to undergo partial resection of the tongue. He underwent radical dissection of the left neck as the second operation and partial resection of the mandible with submental dissection as the third one. Semiawake endotracheal intubation was facilitated with NLA so as to prevent respiratory depression due to induction of anesthesia and to establish the airway. Anesthesia was maintained with 67% nitrous oxide in oxygen and intermittent intravenous administration of vecuronium bromide with the concomitant use of fentanyl. This anesthetic management was supplemented with low-dose isoflurane below 0.5% when judged necessary. There were no respiratory or cerebro-cardiovascular complications over any of these three perioperative courses. Plasma concentrations of β-endorphin, ACTH and cortisol were determined during the third perioperative period. Each of these values remarkably increased during and after operative procedures and tended to increase on the first postoperative day over the respective level prior to operation. These results could be interpreted as evidence that physiological responses in the hypophysio-adrenal endocrine system (HAES) remained appropriately functional without becoming exhausted perioperatively. The following is suggested from this study: This anesthetic management can have advantageous anesthetic effects in preserving homeostasis in HAES as an essential self-defense mechanism which secures much earlier awakening and eliminates respiratory complications throughout the perioperative course. Therefore, this anesthetic method, regarded as balanced anesthesia, is particularly useful for safe management of elderly patients with some basic abnormalities undergoing oral and maxillofacial surgical procedures repeatedly at short intervals.

Original languageEnglish
Pages (from-to)667-674
Number of pages8
JournalJournal of Japanese Dental Society of Anesthesiology
Issue number4
Publication statusPublished - 1994 Jan 1


  • an elderly patient
  • balanced anesthesia
  • general anesthetic management
  • oral and maxillofacial surgery
  • repeated operations

ASJC Scopus subject areas

  • Dentistry(all)
  • Anesthesiology and Pain Medicine


Dive into the research topics of 'General anesthetic management with balanced anesthesia in an elderly patient undergoing repeated surgery'. Together they form a unique fingerprint.

Cite this