Masui. The Japanese journal of anesthesiology
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We report an anesthetic management for Cesarean section and clipping of aneurysm in a pregnant woman with a subarachnoidal hemorrhage secondary to a ruptured cerebral aneurysm. Anesthesia was induced with thiopental, vecuronium and sevoflurane, and maintained with sevoflurane (0.5-1%) before the delivery. ⋯ We also infused prostaglandin E1 continuously at a rate of 50-70 ng.kg-1.min-1 to control arterial blood pressure and to maintain good contraction of the uterus during clipping surgery. We conclude that prostaglandin E1 is useful as a vasodilator after delivery because prostaglandin E1 contracts the uterus.
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During inhalation anesthesia using N2O, the intracuff pressure has been reported to increase due to diffusion of N2O into the cuff. The excessive intracuff pressure may produce ischemia of the tracheal mucosa. In this study, the changes in the intracuff pressure of endotracheal tube with a cuff made of a material with high N2O gas-barrier properties were compared with those of the normal endotracheal tubes. ⋯ A marked increase of the pressure was observed after inhalation of N2O in standard and profile cuff groups. In gas-barrier cuff group, there was a tendency of increasing cuff pressure without a statistically significant difference. The present study suggests that the use of a cuff with a material of high N2O gas-barrier properties would be effective to prevent increased intracuff pressure by N2O diffusion, and this would be especially useful during long anesthesia and hypotensive anesthesia.
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The relative accuracy and precision of the two non-invasive thermometry systems, FirstTemp (Intelligent Medical Systems, USA), an infrared tympanic thermometer, and CTM-205 (Terumo, Japan), a newly developed deep body thermometry system, were evaluated in 32 patients undergoing various surgeries under general anesthesia using esophageal temperature as the reference value. The "limits of agreement (mean difference +/- 2SD)" of the "core" temperature measured by FirstTemp and esophageal temperature was 0.4 +/- 0.5 degrees C, and was larger (P < 0.01) than those between rectal temperature and esophageal temperature (0.2 +/- 0.7 degrees C), between tympanic membrane temperature and esophageal temperature (-0.1 +/- 0.4 degrees C), and between "forehead deep body temperature" measured by CTM-205 and esophageal temperature (-0.2 +/- 0.7 degrees C). ⋯ The repeatability of the measurement by FirstTemp was good; the difference between paired measurement values was 0 +/- 0.2 degrees C (mean +/- 2SD). We conclude that the relative accuracy and precision of the two systems are still not sufficient for monitoring body temperature during general anesthesia.
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Case Reports
[Six cases of epidural abscess probably caused by epidural block and examination by gadolinium-MRI imaging].
We treated six cases of epidural abscess caused probably by epidural block. Three patients were given only chemotherapy and the other three underwent surgical treatment. ⋯ Accelerated blood sedimentation rate, positive CRP results and abnormal findings at the site of the catheter insertion appeared to be important initial signs for the early discovery of epidural abscesses. The route of infection, selection of treatment methods, methods of prevention and examination by Gadolinium-MRI imaging were also discussed.
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Nitrous oxide diffuses into endotracheal tube cuff and then overexpand the cuff. This causes upper airway obstruction and trauma in intubated patients during general anesthesia. On the other hand, pressure of endotracheal cuff is reported to decrease in time-related fashion under artificial ventilation with oxygen and air. ⋯ Clinically sealing pressure was 11.6 +/- 1.0 mmHg and necessary volume of air was 5.5 +/- 1.8 ml. The initial pressure of the inflated cuff gradually decreased to clinical sealing pressure during 130.9 +/- 30.5 min. In conclusion, when regurgitation should be prevented at the point of the clinically sealing pressure, pressure and volume of inflated cuff by air should be re-checked at an interval of about 2 hrs in intubated patients under general anesthesia without nitrous oxide.