Masui. The Japanese journal of anesthesiology
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A 5-year-old girl with Rubinstein-Taybi syndrome (RTS) was scheduled for ophthalmic surgery under general anesthesia. RTS is a well-defined syndrome with facial abnormalities including a high palate and micrognathia, broad thumbs and big toes, and mental retardation as main clinical features, which may be complicated with repeated respiratory infections, cardiac anomalies, and so on. ⋯ Special attention was paid to the possibilities of the difficult airway, aspiration pneumonia and cardiovascular dysfunction during anesthesia. No complications were observed throughout the perioperative procedures.
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Postoperative analgesia by continuous epidural morphine infusion after spinal surgery was investigated in a retrospective study. An epidural catheter was placed by surgeons at the time of surgery. ⋯ There were no severe complications except for respiratory depression in a patient with chronic obstructive pulmonary disease. Our study demonstrated the ease of insertion of an epidural catheter at the time of surgery and the good quality of epidural analgesia after spinal surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
[The effect of preoperative epidural morphine on postoperative pain].
Postoperative analgesia was assessed by examining nurses' records of 421 gynecological operative cases between January, 1989 and November, 1990. The criterion used in the analysis was the need for analgesics for pain within 24 hours postoperatively. After receiving morphine (2 mg, 4 mg, 5 mg, 6 mg) with local anesthetics or physiological saline solution into the epidural space (lower thoracic, lower lumbar, or both regions), the patient was intubated with thiopental, diazepam, and a muscle relaxant (vecuronium or pancuronium). ⋯ The percentage of patients without pain was significantly larger in the group receiving 6 mg of morphine even in comparison with the groups receiving lesser doses. No serious complications occurred postoperatively in any group. In conclusion, preoperative morphine administered into the epidural space is effective for postoperative analgesia in gynecological operation, especially when morphine 6 mg was administered in the lower epidural (4 mg) and lower lumbar epidural (2 mg) space.
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We report anesthetic management of a patient with laryngotracheoesophageal cleft which lacks partition between the esophagus and upper airway, a rare congenital anomaly with a high mortality. A male baby weighting 2.96 kg was born at 39-week gestation. He had respiratory distress, hoarse cry and cyanosis on feeding. ⋯ Endoscopic examination performed transnasally and through the endotracheal tube demonstrated that the septum between the trachea and esophagus was absent from the larynx through the entire length of the trachea. On the basis of these finding, this case was diagnosed as laryngotracheoesophageal cleft (type 3). Esophageal division and gastrostomy were performed to prevent regurgitation and aspiration of gastric content.
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Comparative Study Clinical Trial Controlled Clinical Trial
[Insertion characteristics and complications of a new spinal needle 26-gauge Atraucan].
We evaluated the insertion characteristics and complications of a new spinal needle 26-gauge Atraucan (group A) compared with 27-gauge Whitacre (group W) in 100 patients undergoing orthopedic surgeries of the lower extremities. Spinal anesthesia was performed in the lateral decubitus position and 0.40-0.5% tetracaine 1.6-2.5 ml was injected through the L 3/4 or L 4/5 interspace. The tactile appreciation of dural presentation with the needle (dural click) was higher in group W (89.8%) than in group A (42.6%) which the back flow of cerebrospinal fluid was not recognized within three punctures was in 2 cases (4%) in group A and in 1 case (2%) in group W. ⋯ In group A, the spinal needle could be inserted without using an introducer in 35 cases (70%). The incidence of the postoperative headache or back pain was low and postdural puncture headache (PDPH) did not occur in both groups. We conclude that 26-gauge Atraucan can be handled easily and useful for preventing PDPH.