Masui. The Japanese journal of anesthesiology
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We investigated the correlation between the endogenous hormonal changes of pituitary-adrenal and pituitary-thyroid hormones and the prognosis of patients in multiple organ failure, and elucidated the mechanism of blunted thyrotropin (TSH) secretion by histological and immunocytochemical studies of anterior pituitary glands. ⋯ Decreased cortisol, low T4 levels and blunted TSH response to TRH correlated with mortality in MOF patients. Histological and immunocytological studies suggest that blunted TSH secretion is not caused by pituitary damages or TSH exhaustion but by disturbances in TSH secretion. This blunted TSH secretion is reversible and its improvement is an indicator of survival.
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Recently we reported a case of inadvertent migration of an epidural catheter into the endothoracic fascia. Anesthetic injection into the fascia brought a broad unilateral analgesia. To clarify the mechanism of anesthesia. ⋯ The crimson dye, the substitute of the anesthetic agent, reached the transversial fascia in the abdominal cavity through medial and lateral arcuate ligament. Subcostal nerve, iliohypogastric nerve, ilioinguinal nerve, genitofemoral nerve and lateral femoral cutaneous nerve were found to be in the course of dye dispersion. The renal adiposal fascia plays a role of a reservoir for the anesthetic agent and prevents the further anesthetic dispersion.
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We report a case of intracranial subdural hematoma following spinal anesthesia in a 28-year-old woman. Subdural hematoma is a very rare, but life-threatening complication. When a patient complains of persistent post spinal headache, one should consider the possibility of subdural hematoma and carry out a careful examination, including MRI or CT scan.
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Clinical Trial Controlled Clinical Trial
[Evaluation of midazolam premedication for preoperative anxiolysis].
To evaluate the anxiolysis property of midazolam, 60 patients undergoing minor gynecological surgery were given midazolam 0 mg (n = 20), 2.5 mg (n = 20) or 4 mg (n = 20) intramuscularly as premedication 1 h before their entrance to operating theater. The degree of anxiety was evaluated objectively using the State-Trait Anxiety Inventory (STAI). ⋯ In only midazolam 4 mg group, anxiety was reduced significantly in the operating room compared to the day before operation. It is concluded that midazolam (4 mg) is suitable to reduce the preoperative anxiety in patients who are to undergo minor gynecological surgery.
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A case of severe supine hypotensive syndrome in a parturient associated with breech presentation was presented. It is suggested that failure of left tilt to prevent the hypotension was associated with anatomical displacement of the uterus to the right. The importance of trying right tilt, if response to left tilt is poor, is emphasized.