Masui. The Japanese journal of anesthesiology
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A 58 year old man in status asthmatics refractory to drug therapy, was relieved by long-term isoflurane inhalation. In status asthmatics, it takes long time to recover from airway-damage, and inhalation-time will be prolonged in many cases. ⋯ Especially, isoflurane did not cause an increase in the serum fluoride revel, and will not lead to renal insufficiency in spite of its inhalation for 120 hours. It seems that isoflurane is suitable for long-term inhalation.
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We measured the density and specific gravity at room (20 degrees C) and body (37 degrees C) temperatures of spinal anesthetic solutions, which have been commercially prepared in Japan. Solutions investigated were; (1) 0.4 % and 0.5 % tetracaine (T) in water, 0.5 % T in normal saline, 5 % glucose and 10 % glucose, (2) 0.3 % dibucaine in 5 % sodium chloride: (P), (3) 0.24 % dibucaine with 0.12 % tetracaine in 9.5 % glucose: (N); (4) 3 % lidocaine in 8.5 % glucose: (X); and (5) 0.5 % bupivacaine in water containing preservatives: (M). We also determined the density and specific gravity of normal human cerebrospinal fluid (CSF) in Japanese (n = 10) at 37 degrees C. ⋯ Thirty seven centigrade 0.5 % T in normal saline and 37 degrees C 0.5 % M in water had the density comparable to 37 degrees C human CSF and were considered to be relatively isobaric solutions. Our data demonstrated that human CSF had various densities. Therefore, it is possible that these isobaric solutions would vary their pharmacodynamic profiles in intrathecal use according to individual CSF characteristics and temperature of the solution.
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We compared the damaging effect on myelinated nerve of alcohol and that of phenol. Guinea pigs of approximately 300 g in weight were used. Right sciatic nerve was exposed after intraperitoneal administration of pentobarbital. ⋯ Toe necrosis was found in 2 cases in the second group, 3 cases in the third, null in the fourth and 6 cases in the fifth group. We concluded that damage was larger with phenol than with alcohol when administered intraneurally, but the difference was not significant. Alcohol administered inside or outside of the epineurium made no significant changes, but phenol administered only inside the epineurium made a significant damage.
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A newborn female infant born at 41 week gestation with Nager acrofacial dysostosis had no congenital abnormalities in her parents and closed relatives. Her mother had uncomplicated pregnancy and normal delivery. ⋯ A laryngeal mask was placed after several trials of intubation, and ventilation was carried out successfully. We consider that the use of a laryngeal mask is one of the best ways in a case of difficult intubation.
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Clinical Trial Controlled Clinical Trial
[The clinical usefulness and problem of combined spinal epidural needle].
The clinical usefulness of combined spinal-epidural needles, Portex Spinal/Epidural set (Pencil point tip type and Lancet point tip type), was evaluated on 30 patients undergoing orthopedic lower limb surgeries, hysterectomies or transurethral surgeries. In all the patients, the spinal-epidural needles were successfully inserted with paramedian approach without any problem. ⋯ It is possible that the hole in the dura may allow a transfer of local anesthetics into the subarachnoid space. The present study shows that combined spinal-epidural block is clinically useful, and the Pencil point type is safer than the Lancet point type.