Masui. The Japanese journal of anesthesiology
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A 24-year-old, 48 kg female with Charcot-Marie-Tooth disease, mitral valve prolapse syndrome and IInd degree AV block was scheduled for emergency cesarean section under epidural anesthesia. This anesthesia was chosen because she had heart disease. Furthermore, the combination of general anesthesia with neuromuscular blockade posed the risk of a prolonged response to muscle relaxants and resulting respiratory insufficiency. ⋯ Epidural anesthesia was safely performed during the operation. Postoperatively, there were no signs of respiratory or neurologic dysfunction. In conclusion, epidural anesthesia seems to be a good choice for a patient with Charcot-Marie-Tooth disease.
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It has been reported that subcutaneous administration of pancuronium produces prolonged neuromuscular blockade. The purpose of this study was to evaluate the antagonistic effect of neostigmine on neuromuscular blockade following subcutaneous injection of pancuronium in anesthetized patients. Fourteen male patients aged 32-67 yr, weighing 50-58 kg, and scheduled for surgical operation lasting more than 6 hr were included in the study. ⋯ Time intervals to maximum train-of-four depression from pancuronium administration in groups A and B averaged 2.6 and 125.4 min, respectively. No significant differences in the recovery times of the train-of-four ratios from 0.2 to 0.7 following neostigmine administration in groups A and B were demonstrated. None of the patients who received pancuronium subcutaneously showed recurarization following neostigmine administration.(ABSTRACT TRUNCATED AT 250 WORDS)
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We measured fluctuation of injection pressure by several types of commercially available syringe pumps in order to investigate the effect of syringe volumes (Terumo syringe) and speed settings on the irregularity of injection speeds. We recorded the injection pressure continuously with various speed settings, except that one of the pumps injected irregularly at the settings of 2 and 1 ml.h-1. With 50 ml syringes, only two of the six pumps injected precisely at all the speed settings. ⋯ With 30 ml syringes, injection pressures fluctuated in most of the six syringe pumps at a speed lower than 5 ml.h-1. In conclusion, changes in injection pressures depend on types of syringes, syringe volumes and speed settings. We urge not to use a 30 ml syringe to infuse vasoactive drugs with syringe pumps.
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In 31 cases of trans-urethral resection of the prostate (TUR-P), the lumbar epidural block was carried out with the catheter placed caudad. In 23 of 31 cases, it was found that the catheters were inserted caudad with coiling, but not so distant from the puncture site. In 3 cases, the catheters were placed caudad beyond a vertebral segment, in 2 cases cephalad, in another 2 cases passed through the intervertebral foramen, and in the other case the position undetectable. ⋯ In 3 cases, the catheters were successfully placed caudad beyond a vertebral segment and the levels of analgesia 10 minutes after the injection were T11-T10 to S3-S5. In the anesthetic management of TUR-P, it is necessary to obtain complete analgesia in sacral segments and to avoid high thoracic epidural block. We concluded that this method was useful for the anesthetic management of TUR-P.