Masui. The Japanese journal of anesthesiology
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We evaluated retrospectively the complications of pediatric spinal anesthesia in our center based on the histories of 50 spinal anesthesia cases (5-15 years of age, 0.56%) over the last 15 years. Five cases (10%) showed transient hypotension. ⋯ Because of low incidence of complications, pediatric spinal anesthesia is a useful method especially for patients with respiratory insufficiency. It is advisable to watch carefully for changes in blood pressure in senior infants, and to avoid spinal anesthesia in patients with giant abdominal tumors.
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Postcordotomy dysesthesia was classified from the clinical features of dysesthesia following percutaneous cervical cordotomy (PCC) in 66 patients. Dysesthesia occurred in 10 (15.2%) of 66 patients and was classified into three types. In the first type, dysesthesia occurred at the region where pain had been before PCC, and pain sensitivity had been lost due to PCC. ⋯ In the third type, dysesthesia occurred at the region where pain had been before PCC and pain sensitivity had partially recovered. This type of dysesthesia occurred in 3 patients. The reduction of the effect of PCC was presumably the cause of this type of dysesthesia.
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Case Reports
[Perioperative management of the patient with hypertrophic obstructive cardiomyopathy].
We experienced the perioperative management of a patient with hypertrophic obstructive cardiomyopathy, who underwent open heart surgery. We performed three kinds of overload examinations, which included overdrive test using the pacemaker, continuous dopamine infusion with overdrive test and continuous diltiazem infusion with overdrive test, before and after cardio-pulmonary bypass under observation of the cardiac performances with transesophageal echocardiogram. We gained some important and interesting informations about the cardiac reserve of the patient. We could perform adequate perioperative management for the patient, taking the results of overload examinations into consideration.
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To evaluate in man the potentiation by nitrous oxide of the neuromuscular blockade produced by pancuronium, pancuronium 0.025, 0.035, 0.049 or 0.068 mg.kg-1 was given during thiamylal-fentanyl anesthesia with and without nitrous oxide, and the evoked electromyography (EMG) of hypothenar muscle was measured. In the group receiving nitrous oxide the ED50 and ED95 were 0.0359 and 0.0691 mg.kg-1. In the group not receiving nitrous oxide, these values were 0.0389 and 0.0849 mg.kg-1. ⋯ It was also revealed that the magnitude of the blockade was influenced by dose, gender, nitrous oxide, lean body mass and body surface area by the multiple regression analysis. DRS for the female patients shifted to the left, and the differences between both sexes seemed to decrease in the group receiving nitrous oxide. It is concluded that the results of the present study appears to be similar to those obtained in the previous study on vecuronium using EMG.
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Case Reports
[Anesthetic management for cesarean section in patients with maternal myotonic dystrophy].
Myotonic dystrophy involves not only voluntary muscles of extremities, pharyngeal muscle and respiratory muscle but also smooth muscle in the gastrointestinal tract. This muscle involvement can cause difficulty in excreting sputa, delayed emptying time of stomach and regurgitation of gastric content, all of which can lead to disastrous complications of anesthetic management. ⋯ In one case, the newborn baby had dyspnea due to congenital myotonic dystrophy, and in another case, patient experienced postoperative pneumonia. Our cases and other reports suggest that spinal or epidural anesthesia is safely applied for a cesarean section of a patient with myotonic dystrophy.