Masui. The Japanese journal of anesthesiology
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We evaluated EEG pattern during total intravenous anesthesia with droperidol, fentanyl and ketamine (DFK). Four surgical patients, ranged in age from 35 to 43, were the subjects of this study. Two male underwent oral or orthopedic surgery and the other two female patients underwent gynecological surgery. ⋯ We used HZI'Brain Function Monitoring system to evaluate their EEG patterns. When adequate depth of anesthesia was obtained as clinically evaluated by vital signs, theta wave pattern was dominant on the EEG tracings in any of these patients. DFK anesthesia would provide a stable anesthetic course, if those drugs are administered adequately considering vital signs including systemic blood pressure, heart rate, lacrimation and involuntary muscle movements of the face and extremities.
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We gave anesthesia for cesarean section to 30 year-old female with HELLP syndrome with bronchial asthma. HELLP syndrome is characterized by hemolysis, liver dysfunction and thrombocytopenia, besides syndrome of severe toxemia of pregnancy. ⋯ Though she had improvements of liver dysfunction and thrombocytopenia after operation, it took 2 days to extubated, because she had frequent attacks of bronchial asthma. We conclude that we should perform cesarean section for a patient with HELLP syndrome as soon as possible.
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Case Reports
[Anesthetic management of a patient with pemphigoid for prosthetic replacement after femoral neck fracture].
We report an 83 year-old male with pemphigoid who underwent replacement of a femoral neck prosthesis following femoral neck fracture. Problems associated with anesthetic management of patients with vesiculobullous diseases such as pemphigoid include fluid, electrolyte and protein loss, and secondary infection because of the fragility of the skin and mucous membranes. Avoidance of trauma to the skin and mucous membranes is therefore important. ⋯ The patient was successfully anesthetized with spinal anesthesia using 2.5 ml of tetracaine in a 0.4% solution of 0.45% NaCl. An evacutable mattress was used to protect the patient from pressure points in the lateral position, and to minimize the hazards from pressure by spreading the weight. Surgery proceeded uneventfully and the postoperative period was uncomplicated.
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[Transdermal application of 10% lidocaine-gel for management of pain associated with herpes zoster].
We have developed transdermally applicable 10% lidocaine aqueous gel containing an absorption promoter and applied it for 15 patients suffering from severe pain in acute or subacute phase of herpes zoster. The patients, consisting of 7 males and 8 females with a mean age 58.5 +/- 13.0 (SD) yrs, had skin eruptions of herpes zoster for the past 2 months. Lidocaine-gel was applied locally to the diseased skin with or without an occlusive dressing. ⋯ There was no adverse systemic reactions or local skin damages. None of them developed post-herpetic neuralgia. The lidocaine-gel treatment appears to be very useful for reduction of pain associated with acute or subacute phase of herpes zoster.
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To evaluate the present status of surgical transfusion during operations, we computed the amount of preoperative preparation and intraoperative use of blood. And we examined cross-match to transfusion ratio (C/T ratio) and maximum surgical blood order schedule (MSBOS) based on the statistical data in our hospital. The result revealed that too much blood was prepared in our hospital. ⋯ The mean C/T ratio was 5.30. And a trial of MSBOS revealed that we could save 70% of the blood presently prepared. We are sure that the introduction of T & S and MSBOS will lead to more efficient transfusion in our hospital.