Masui. The Japanese journal of anesthesiology
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Perioperative airway management for sleeve pneumonectomy in a 66-year-old female with tuberculous tracheal stenosis which was 2 cm above the carina to the right main bronchial orifice is reported. Endotracheal intubation was required, because she complained of dyspnea due to airway stenosis in preoperative period for anti-tuberculous chemotherapy. A special tracheal tube developed for laryngomicrosurgery (MLT tube, Mallinckrodt Co. ⋯ However, 13 days after intubation with an MLT tube, sleeve pneumonectomy was done because because of right lung atelectasis and progressive hypoxemia. Left one lung ventilation was successful by an MLT tube during right thoracotomy and a spiral tube (28 Fr) was inserted to the left main bronchus in the operative field during the resection of the carina. For this type of patient with tracheo-bronchial stenosis, it is essential to select an endotracheal tube with appropriate length and diameter.
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In order to investigate effects of addition of fentanyl epidurally on the onset of sympathectomy from epidural lidocaine, we have measured the toe temperature of 29 healthy patients undergoing elective lower extremity or lower abdominal surgeries. The latency of onset of the toe temperature was significantly shorter in patients receiving both epidural lidocaine and fentanyl compared with those receiving epidural lidocaine alone (258 +/- 135 vs 398 +/- 184 sec, P < 0.05 [mean +/- SD]). Osmolarity and pH of the epidural solutions were similar between the two groups. These results suggest, but do not indicate, that sympathectomy from epidural lidocaine is accelerated by the addition of fentanyl.
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Today many aspects of neuromuscular block should adequately be assessed. Post-tetanic count is applied for evaluating intense neuromuscular block and double burst stimulation for residual neuromuscular block. However, very profound neuromuscular block can not be evaluated using the post-tetanic count, and in addition, adequate level of recovery from neuromuscular block can not be identified using the double burst stimulation. Post-tetanic burst and double burst stimulation are thought to be useful for quantifying intense and residual block, respectively.
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Comparative Study
[A comparison of various ways of cardiac output measurement by thermodilution methods].
We compared cardiac output values obtained by the following 3 methods: 1. Iced bolus injectate method, using the injectate temperature actually measured for computation [bolus cardiac output with flow-through temperature probe: BCO (p)]. 2. Continuous cardiac output measurement, using Vigilance system (continuous cardiac output: CCO). 3. ⋯ Although BCO correlated well with BCO(p), the bias was much greater (r2 = 0.919, P < 0.0001, bias = -1.25 l.min-1, SD = 0.45 l.min-1) than BCO(p). In conclusion, the values obtained by BCO(p) and CCO methods were very accurate. On the other hand, a considerable overestimation was found with BCO since the compensation for actual injectate temperature was not performed
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Case Reports
[Post dural puncture headache (PDPH) which occurred after the removal of an epidural catheter].
A 57-year-old man received gastrectomy under general anesthesia combined with epidural anesthesia. He showed no signs of dural puncture and catheter migration into the subarachnoid space. Cardiovascular status was stable with epidural injection of lidocaine, morphine during the operation. ⋯ PDPH persisted over a period of 30 days and was treated with an epidural blood patch and stellate ganglion blocks since the other conservative therapy had been ineffective. We consider that administration of continuous epidural opioids for postoperative analgesia helped to prevent PDPH until the 7th postoperative day. We also conclude that prolonged PDPH after using a thick needle like a Touhy needle should be treated by an epidural blood patch.