[Ultrasound-guided Thoracic Epidural and Spinal Anesthesia for the Management of Patients Undergoing Systemic Neurofibroma Resection].

We report successful anesthetic management of a patient undergoing systemic neurofibroma resection using thoracic epidural and spinal anesthesia. A 40- year-old man (weight 66 kg) with von Recklinghausen's disease and intermittent convulsions was scheduled for large-scale tumor resection on the back and arms. He also had chronic obstructive pulmonary disease and stiff neck We decided not to perform operation under general anesthesia. Before epidural or spinal anesthesia, we confirmed that there were no fibromas -in the subdermal lesion for needle progression by ultraso- nography. Thoracic epidural anesthesia was performed at the T2-3 level with 0.25% ropivacaine 5.0 ml, and spinal anesthesia with 0.5% isobaric bupivacaine 3.0 ml. To calm his anxiety, we continuously adminis- tered dexmedetomidine 0.4-0.8 μg · kg(-1) - hr(-1). The operation was performed uneventfully without se- vere pain. Dexmedetomidine was continued until the next morning. The patient showed no signs of convul- sions or intractable pain postoperatively.