Masui. The Japanese journal of anesthesiology
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Comparative Study Clinical Trial Controlled Clinical Trial
[Epidural administration of buprenorphine after combined spinal epidural anesthesia].
We compared the efficacy of epidurally administered buprenorphine (0.2 mg) after combined spinal-epidural anesthesia (CSE group) and that after general anesthesia combined with epidural anesthesia (EPI + GEN group). Postoperatively epidural buprenorphine was administered for initial pain relief significantly later in CSE group than in EPI + GEN group. ⋯ The time period until postoperative first walk and the number of pain relief medication were also similar in both groups. We had the impression that the onset of pain relief was faster in CSE group, probably because there might be flux of buprenorphine through a dural hole just after epidural administration.
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Case Reports
[Postoperative continuous epidural infusion of morphine in a patient with myotonic dystrophy].
Patients with myotonic dystrophy present potential problems during and after anesthesia, especially respiratory dysfunction. A 42-year-old female with myotonic dystrophy associated with slight impairment of respiratory functions and muscular power, underwent abdominal total hysterectomy under epidural anesthesia uneventfully. ⋯ She obtained adequate analgesia after the surgery without respiratory depression or other major complications. We demonstrated that the continuous epidural infusion of morphine in a patient with myotonic dystrophy is safe and adequate for postoperative pain relief.
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Case Reports
[Anesthesia for bilateral volume reduction surgery in a patient with severe bullous emphysema].
An 80-year-old male with severe bullous emphysema underwent bilateral volume reduction surgery. He had suffered from dyspnea and was classified into Hugh-Jones III. In spirogram, forced vital capacity in 1 second was markedly low (0.38 l, corresponding to 19.4 % in % FEV1.0). ⋯ We used a critical care type ventilator (Servo 900C, Simens) for pressure controlled ventilation for fear that positive pressuse ventilation creates or aggravates airleaks. Surgery and anesthesia were performed uneventfully. We recommend lower concentration of a volatile agent combine with thoracic epidural analgesia and pressure controlled ventilation for the volume reduction surgery.
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We experienced delayed rupture of a balloon reservoir in a disposable infusion pump 3 hours after filling. The investigation revealed a sharp scratch in the reservoir. Furthermore, as we did not filtrate the drugs before filling, we speculate that ampule fragments could have provoked the rupture. When filling a disposable infusion pump with ampule solution, filtration against glass contamination is recommended.
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For resolving the discrepancy of concentrations found among anesthetic gas monitors, the author proposed a new method using a vaporizer as a standard anesthetic gas generator for calibration. In this method, the carrier gas volume is measured by a mass flow meter (SEF-510 + FI-101) installed before the inlet of the vaporizer. The vaporized weight of volatile anesthetic agent is simultaneously measured by an electronic force balance (E12000S), on which the vaporizer is placed directly. ⋯ These monitors are normalized by the linear equation describing the relationship between concentrations of calibration gases and readings of the anesthetic gas monitors. By using normalized monitors, flow rate-concentration performance curves of several anesthetic vaporizers were obtained. The author concludes that this method can serve as a standard in evaluating anesthetic vaporizers.