Masui. The Japanese journal of anesthesiology
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Comparative Study
[Comparison of sevoflurane and halothane in pediatric anesthesia].
In the present study we compared sevoflurane (group S) and halothane (group F) as used in pediatric endotracheal anesthesia. The subjects consisted of 100 pediatric patients, each 50 in group S and F, most of whom underwent otorhinolaryngological surgery. Anesthesia was induced with nitrous oxide-oxygen-sevoflurane (GOS) (S 3-5%) or nitrous oxide-oxygen-halothane (GOF) (F 1.5-2.5%), and maintained with GOS (S 2-3%) or GOF (F 1.0-1.5%). ⋯ When the groups were compared for awakening from anesthesia, group S required 10.1 min for awakening and 11.9 min for extubation, while in group F the time was 13.0 min and 15.4 min, respectively. These values were significantly different. The present study demonstrated that sevoflurane anesthesia is rapid in both induction and awakening as compared with halothane anesthesia, and that GOS inhalation anesthesia with single use of sevoflurane can be usefully applied to pediatric endotracheal anesthesia.
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Preterm infants may become apneic during immediate postoperative period. We studied prospectively postoperative apneic attack in 167 preterm infants after inguinal herniorrhaphy with nitrous oxide-halothane anesthesia. Their mean gestational age was 30 +/- 3 weeks. ⋯ The mean birth weight was 1351 +/- 395 kg. Although many of them had a risk factor of postoperative apneic attack, i.e.a young post-conceptual age (less than 41 weeks), a light weight at operation (below 3000g), only one infant who had received emergency operation had an episode of apneic attack up to 2 postoperative days. For preventing postoperative apneic attack in preterm infants after inguinal hernia, we recommend the use of halothane anesthesia and the attention until a complete awakening.
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Case Reports
[A case of radiculitis induced by spinal cord electrical stimulation by a percutaneously inserted needle].
Spinal cord electrical stimulation was performed by a percutaneously inserted needle for causalgia of the right upper limb. The end of electrode was positioned along a line extending down the 5th vertebral body in the vicinity of the right 6th cervical nerve root, after which it was permanently implanted following confirmation of desensitizing effects. Although the patient later returned to normal life without requiring any ancillary medication, beginning after a period of roughly six months, the pain suddenly began to increase when stimulated. ⋯ After selective radicular block, the patient's complaint diminished. Based on the above findings, we consider that the physical stimulation caused by the electrode in contact with the nerve root brought about inflammation of the 6th cervical nerve root. This patient was then treated by removing the causative stimulation and selective radicular block of affected nerve, the details of which are reported.
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Intraoperative delayed pneumothorax occurred in five patients. It took several attempts to insert a subclavian vein catheter in four of the patients. ⋯ In case of positive pressure ventilation and nitrous oxide administration for general anesthesia, this complication may be life threatening. It is necessary to take great care not to overlook intraoperative delayed pneumothorax in a patient with subclavian vein catheterization.
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Case Reports
[A critical patient relieved from status asthmaticus with isoflurane inhalation therapy].
In cases of life-threatening status asthmaticus which are refractory to drug therapy, the administration of inhalation anesthetics can be life-saving as they help alleviate bronchial spasm. We had an 11-year-old female patient suffering from status asthmaticus who was moribund from severe CO2 narcosis and was not responding to any of the conventional therapies. She finally fell into ventricular fibrillation. ⋯ The endotracheal tube was removed 4 hours later. She had an uneventful recovery and was discharged from the hospital 11 days later. With its low metabolic rate and therefore low organ toxicity, as well as its low arrhythmogenicity with remarkable bronchodilating activity, we feel isoflurane may well be superior to other inhalation anesthetics in the treatment of status asthmaticus.