Masui. The Japanese journal of anesthesiology
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Case Reports
[A case of emergency admission for CO2 narcosis in a patient with amyotrophic lateral sclerosis].
A 68-year-old man with severe dyspnea was admitted as an emergency case. He had no past history of any respiratory or neuromuscular diseases. Immediately after insufflation of oxygen, respiratory arrest occurred. ⋯ We conclude that if we meet with an emergency patient with CO2 narcosis without any pulmonary disorder, we have to suspect neuromuscular diseases, e.q. ALS. In some of such cases, mechanical ventilation supports social rehabilitation.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Comparison of airway complications on tracheal extubation in deeply sevoflurane anesthetized versus awake children].
We investigated the incidence of respiratory complications and oxygen saturation level during emergence from sevoflurane anesthesia in children whose tracheas were extubated while they were anesthetized or after they became awake. Thirty children, aged 1-10 years, were studied. Anesthesia was induced with sevoflurane or thiopental and maintained with nitrous oxide, oxygen and sevoflurane. ⋯ There was a significantly higher incidence of the airway obstruction but less incidence of cough and breath-holding in anesthetized group. Oxygen saturation level before and after tracheal extubation was not different between the two groups. In conclusion, with proper attention to airway obstruction, it may be possible to extubate while children are deeply anesthetized with sevoflurane.
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Randomized Controlled Trial Clinical Trial
[Effects of preoperatively administered flurbiprofen axetil on the action of inhaled anesthesia and postoperative pain].
Flurbiprofen axetil (FP) was evaluated in a randomized study relative to placebo in 26 patients undergoing endonasal ethmoidectomy. The FP group (n = 13) was administrated 1 mg.kg-1 FP 15 minutes before operation during a half hour. Likewise, the control group (n = 13) received intravenous NaCl 0.9%. ⋯ Body temperature of the FP group fell significantly before infusion. The FP group showed lower pain scores and required less dicrofenac sodium than the control group (P < 0.05). This study suggests that preoperative FP infusion relieves postoperative pain, but does not affect the action of the inhalation anesthetic.
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In 1984, Cormack and Lehane defined laryngoscopic view in four grades. As the view worsens, the difficulty of intubation may increase but it is not clear. In this study, we examined the endotracheal intubation techniques to the grade III or IV airways. ⋯ In conclusion, the grade III or IV airways were not always difficult to intubate. But when the conventional technique failed, the gum-elastic bougie or laryngeal mask airway was a fairly useful aid to endotracheal intubation. Moreover our handmade flexible guide tube made the intubation through the laryngeal mask airway safe and reliable.
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We described a case of anaphylaxis diagnosed by the evaluation of plasma mast cell tryptase and a case of anaphylactoid reaction. In a patient undergoing pulmonary lobectomy, anaphylaxis, showing the elevation of plasma tryptase, was provoked by physiological glue for hemostasis during the operation. During the operation, cardiovascular collapse occurred suddenly, at which time the cause was not diagnosed. ⋯ Increase in plasma histamine concentration to 4.94 ng.ml-1 that could induce systemic reaction was noticed; however, concentrations of plasma tryptase 25 min, 3h and 7h after the episode were not elevated. This finding indicated that the adverse reaction was not based on degranulation of mast cell, and was anaphylactoid reaction provoked by nonspecific histamine-release. In conclusion, measurement of plasma tryptase is a useful method for differential diagnosis of anaphylaxis and anaphylactoid reaction.