Masui. The Japanese journal of anesthesiology
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Oro-tracheal intubation to prevent the development of subcutaneous emphysema after blunt trauma by a traffic accident resulted in progressively worsening dyspnea because of complete transection of the trachea. Emergent tracheal reconstruction was required for life-saving. In order to secure a safe and effective airway in such a patient, we should diagnose accurately and select the methods of securing the airway earlier in the post-traumatic period.
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Eleven healthy pregnant women were studied to determine temperature changes after induction of epidural anesthesia during cesarean delivery. Epidural anesthesia was induced by 2% lidocaine 15-20 ml (T 5 level) at 25 degrees C ambient temperature. Tympanic membrane and skin surface temperature, skin-temperature gradients (forearm-fingerchip, calf-toe), thermal perception (1-10 scale VAS) and the presence or absence of shivering were measured. ⋯ Temperature gradients of upper limb increased to 2.0 +/- 3.7 degrees C (50 minutes after induction) and the lower limbs decreased to -1.4 +/- 0.55 degrees C (30 minutes after induction). Shivering occurred in 3 patients. We conclude that epidural anesthesia impaired thermoregulatory control and induced redistribution hypothermia as in nonpregnant individuals.
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We investigated the analgesic effect of dextromethorphan (DM), a non-selective NMDA receptor antagonist, in 25 patients with postherpetic neuralgia (PHN). We administered DM 45mg.day-1 orally for 14 days and then 90mg.day-1 for next 14 days. ⋯ Side effects with no severe cases occurred in 8 patients (32%) and these were mainly digestive symptoms. We concluded that DM might be useful to treat PHN with allodynia probably due to central sensitization.
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Intraoperative changes in blood coagulation-fibrinolysis system were evaluated in 21 patients under epidural anesthesia by thrombelastography. Ten patients received transurethral resection of prostate (TUR-P) and 11 patients received transurethral resection of bladder tumor (TUR-Bt). Thrombelastographic variables: reaction time (R), coagulation time (K), maximum amplitude (MA), and amplitude 60 min after MA (A 60) were measured. ⋯ Resected prostatic weight correlated significantly with the decrease of MA, and had a tendency to correlate with the increase of MA-A60 in TUR-P group. Both coagulation and fibrinolysis were activated in TUR-P group. When the resected prostatic weight is large, the risk of coagulopathy may increase.
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The pharmacodynamics of neuromuscular blocking agents in malnutrition have not been well delineated. In the present study, the neuromuscular effects of vecuronium (Vb), d-tubocurarine (d-Tc) and succinylcholine (SCh) in malnutrition were investigated. Male Sprague-Dawley rats aged 7 weeks were divided into malnourished and control groups. ⋯ However, IC50 and IC90 of SCh were significantly lower in the malnourished group than in the control group (P < 0.0001). In this study, malnutrition increased resistance to nondepolarizing neuromuscular blocking agent and sensitivity to SCh compared with the control. These results suggest that malnutrition might induce similar changes of acetylcholine receptor which are observed in denervation or burn injury.