Masui. The Japanese journal of anesthesiology
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Comparative Study Clinical Trial Controlled Clinical Trial
[Comparison of the clinical usefulness of the two types of combined spinal epidural needles].
The clinical usefulness of Combined Spinal-Epidural (CSE) needles, Portex Spinal/Epidural set (P needles) and Hakko Disposable Needles set type H (H needles) was compared on 30 patients undergoing elective orthopedic lower limb surgeries. Although the calibers of the epidural needles were a little different, both needles were introduced quite easily in the epidural space. The spinal needles were inserted successfully to the subarachnoid space in 27 out of 30 cases by the P needles and 23 out of 30 cases by the H needles. ⋯ Adequate spinal anesthesia was established in 26 patients (87%) and 19 patients (63%) by the P needles and the H needles, respectively. One case of the accidental location of the epidural catheter in the subarachnoid space was observed in each group. As the CSE device, the P needles were more sophisticatedly designed for easier insertion to the subarachnoid space than the H needles.
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Clinical Trial Controlled Clinical Trial
[Effect of celiac plexus block and thoracic epidural block on arterial ketone body ratio].
We evaluated the effect of intraoperative celiac plexus block (CPB) and thoracic epidural block (TEB) on arterial ketone body ratio (AKBR) in the patients undergoing total or partial gastrectomy. Mean arterial pressure (MAP), heart rate, AKBR, and arterial blood gas were measured at the end of esophago-jejunostomy, gastro-duodenostomy, or gastro-jejunostomy (pre-block) and at the end of operation (post-block), respectively. After pre-block measurement, CPB with 99.5% ethanol 15-20 ml was carried out in 8 patients with advanced gastric cancer (CPB group); TEB with 2% lidocaine was performed on 8 patients (TEB group); and neither CPB nor TEB was done on 8 patients (control group). ⋯ However, there were no difference in AKBR, pH, and BE between pre-block values and post-block values in TEB group as in the control group. These findings suggest that ethanol used in CPB reduces the redox state of hepatic mitochondria and increases lactate. Therefore we should pay attention to the changes in AKBR, pH, and BE after celiac plexus block with ethanol.
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The significance of phrenic nerve block was studied in the anesthetic management of laparoscopic cholecystectomy. Right phrenic nerve block with 1% mepivacaine 10 ml was performed after the patients were epidurally catheterized and anesthetized with isoflurane and nitrous oxide in oxygen. Intraoperative anesthetic requirement and postoperative shoulder pain incidence in patients with this block were compared with those in patients without block. ⋯ It is known that phrenic nerve contains sensory element and that laparoscopic procedures of gall bladder elicit noxious stimuli which cannot be blocked by ordinary epidural anesthesia for abdominal surgery. Also, shoulder pain is said to be phrenic nerve-mediated referred pain. Our study suggests that blockade of these stimuli is effective in preventing postoperative event rather than intraoperative.
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General anesthesia was given to six surgical patients with hypertrophic cardiomyopathy on eight occasions from 1990 to 1992. Anesthetic courses were uneventful in five patients diagnosed previously as hypertrophic cardiomyopathy. ⋯ A slight hypotension caused by epidural anesthesia had a devastating effect on the patient. The above experiences stress the importance of early diagnosis and careful observation in perioperative period.
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We evaluated the significance of patient's position in the measurement of gastric contents at the induction of anesthesia (n = 18). After the induction of general anesthesia with tracheal intubation, a nasogastric tube (16F) was inserted into the stomach. ⋯ The existence of the gastric content which can not be aspirated with supine position was confirmed. We conclude that it is necessary to place the patient on bilateral decubitus positions besides supine to evaluate the volume of the gastric content correctly.