Masui. The Japanese journal of anesthesiology
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In 161 patients, aged 19-75 yr and subjected to epidural anesthesia for extracorporeal shock wave lithotripsy, the relationships between the spread of lumbar epidural analgesia with 10 ml of 2% mepivacaine and age, height, weight, weight/height ratio, and body mass index were studied. The highest correlation was found between the age and the spread (r = 0.67, P < 0.001). ⋯ The lowest but a statistically significant correlation was found between the body mass index and the spread (r = 0.16, P < 0.05). A strong inverse linear relationship was found between the age and the epidural dose requirement (r = -0.59, P < 0.001).
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Continuous thoracic epidural anesthesia (T4/5) using 4-5 ml.h-1 of 1.5% lidocaine with 1:200,000 epinephrine and inhaled anesthesia using nitrous oxide, oxygen and sevoflurane were performed in two patients, (40 and 22 yr-old females) with myasthenia gravis. This combined anesthetic technique provided muscle relaxation for endotracheal intubation and optimal operating conditions, including muscle relaxation and stability of hemodynamics during transsternal thymectomy. Further, continuous epidural anesthesia using 4 ml.h-1 of 0.25% bupivacaine provided postoperative pain relief without other analgesics and stable postoperative respiratory conditions. In conclusion, we confirm the benefits of this technique which provides not only safe and stable conditions during the surgery, but also an improved comfort for patients in the postoperative period following transsternal thymectomy for myasthenia gravis.
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We studied neuromuscular blocking effects of isoflurane using a neuromuscular transmission monitor in three myasthenia gravis patients. Severity of myasthenia gravis was different among three patients. ⋯ Also, TOF ratio decreased by 12% in a mild case, by 22% in a moderate case, and 48% in a severe case during isoflurane anesthesia. We conclude that in patients with more severe myasthenia gravis, neuromuscular blocking effect of isoflurane is more potentiated.
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It is known that the course of catheter placement is related to the firmness of catheter. This paper reports the results of roentgenographic analysis of the location of catheters (20G PERIFIX SOFT catheter-B. Braun Melsungen-blind tip with three side holes) inserted into the lumbar epidural space in 20 patients. ⋯ From the recent anatomical observation by MRI, epi-dural space takes various figures depend on the location. Since posterior median part is the widest part in lumbar region, catheter placement should be done in this area. This will increase the success of straight placement of the epidural catheter.
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Improvement of perinatal mortality rate in Japan is remarkable for the last two decades, but maternal mortality rate is still relatively high in comparison with the improvement of the perinatal mortality rate. Maternal mortality rate 1991 in Japan was 8.5. Maternal deaths occurred mostly in perinatal period. ⋯ Antacid medications were rare in our study group. After induction of general anesthesia, airway was maintained by masks (36.0%) or endotracheal tube (64.0%). Obstetric analgesia by local anesthetics was not used widely.