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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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.
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The relative accuracy of Thermoscan PRO-1 (Thermoscan, USA), an infrared ear thermometer, in an unadjusted mode was examined in 21 patients under general anesthesia, using the esophageal and tympanic membrane temperatures as the reference values. The correlation coefficient between the temperature measured by Thermoscan PRO-1 and the esophageal temperature, and that between the temperature measured by Thermoscan PRO-1 and the tympanic membrane temperature, were 0.953 and 0.942, respectively (P < 0.01). The "limits of agreement" between the temperature measured by Thermoscan PRO-1 and esophageal temperature, and between the temperature measured by Thermoscan PRO-1 and tympanic membrane temperature, were -0.5-0.4 degrees C and -0.5-0.5 degrees C, respectively. We conclude that Thermoscan PRO-1 is sufficiently reliable for monitoring body temperature during surgery.
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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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We report a case of tracheal rupture associated with use of a double-lumen endobronchial tube. The patient was a 58-year-old woman with metastatic carcinoma of the right upper lung lobe. Her trachea was intubated easily with a left-sided double-lumen endobronchial tube (Broncho-Cath, #35Fr). ⋯ A tracheal rupture, beginning 3 cm above the carina and 7 cm long, was noted at the membranous part of the trachea, and the cuff protruded partially from the ruptured trachea. The trachea was sutured, and a tracheostomy was carried out. Mechanisms of tracheal rupture related to double-lumen endobronchial tubes are discussed.