Masui. The Japanese journal of anesthesiology
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Case Reports
[Conversion to 2nd degree from 1st degree atrioventricular (AV) block by the reversal of neuromuscular blockade].
A case of intraoperative conversion to 2nd degree from 1st degree AV block by the reversal of neuromuscular blockade was reported. A 78 year old male, who originally suffered from 1st degree AV block, underwent choledocholithotomy and T-tube drainage for choledocholithiasis. He was administered 4 mg of pancuronium at the time of intubation. ⋯ We believe that this accident was induced by a vasovagal reflex which was triggered by extubation under the effect of neostigmine which acts longer than that of atropine. We should be careful in reversing the effect of the non-depolarizing neuromuscular blockade. A short acting neuromuscular blockade, i.e. vecuronium, is preferable so as to avoid neostigmine reversal, and extubation should be performed when the effect of neuromuscular blockade is confirmed to be exhausted.
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The size 2, 3 and 4 laryngeal masks (LM) were used in 50 patients having various types of clinical anesthesia. We measured the airway pressure at which gas leak occurred during the use of the LM. We compared the time taken to obtain clear airway, when patients were receiving 4.5 or 6 l.min-1 fresh flow by anesthetic machines. ⋯ In both children and adult, the time interval taken to obtain clear airway by the LM was two-thirds of the time necessary during the tracheal intubation. While the LM or the endotracheal tube was inserted, delta SpO2 and delta HR in children, and delta AP in adult were much smaller in the LM group than in the endotracheal tube group. We conclude that the LM is very useful in the clinical anesthesia, and the LM gives less influence to cardiopulmonary system compared with tracheal intubation while offering clear airway.
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Comparative Study
[Thermographic assessments of the sympathetic blockade by stellate ganglion block (1) Comparison between C7-SGB and C6-SGB in 40 patients].
We compared the degree in sympathetic blockade after C7-SGB (stellate ganglion block at the level of 7th vertebral transverse process) and the one after C6-SGB (SGB at the level of 6th cervical transverse process) using infrared thermography. Forty patients entered this study. C7-SGB was performed in 20 patients using 5 ml of 1% plain mepivacaine at the anterior aspect of 7th cervical transverse process, and C6-SGB in the remainder at the top of the anterior tubercle of 6th cervical transverse process. ⋯ All patients showed Horner's sign. No severe side-effect occurred in either group. In conclusion, while effect of upper cervical sympathetic blockade after C7-SGB was similar to the one after C6-SGB, effect of lower cervical and upper thoracic sympathetic blockade after C7-SGB was more effective than that after C6-SGB.