Masui. The Japanese journal of anesthesiology
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Case Reports
[Anesthetic management involving difficult intubation in a child with Gaucher disease].
Gaucher disease is the most common of the glycolipid storage disorders caused by the deficiency of glucocerebrosidase, an enzyme which hydrolyzes glucocerebroside to glucose and ceramide. Accumulation of the substrate leads to multiorgan dysfunction involving the brain, spleen, liver, lymph node and bone marrow. In anesthetic management, gastroesophageal reflux leading to recurrent aspiration, pancytopenia and airway difficulties due to trismus, neck extension and upper airway infiltration with glucocerebroside must be considered. ⋯ Then, we used this special mask for the next time. Tracheal intubation was much safer by using this mask for fiberoptic intubation. In Gaucher disease, preoperative assessment of airway difficulties and preparation for this situation are necessary and anesthesiologist must be concerned about aspiration and airway difficulties.
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A 71-year-old man was scheduled for laryngomicrosurgery under total intravenous anesthesia. Anesthesia was induced and maintained with propofol. Seven to eight minutes after induction of anesthesia, convulsion was observed first on his lower limbs and then on his all limbs and the head. ⋯ Later neurological examination revealed normal functions. Although the etiology of convulsion by propofol is controversial, the convulsion observed in our patient seems to be related to glycinergic as well as glutamate receptors. When we administer propofol to patients, we should be careful about the occurrence of convulsion.
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We evaluated the temperature dependent flow rate of local anesthetics, 0.25% bupivacaine, in three portable epidural infusion devices, Infusor of Baxter, Surefuser-A of Nipro and Excelfuser of Kobayashi Medical. Flow rate was calculated using a digital precision scale in a large temperature controlled incubator. In two preliminary studies the temperature was 25 degrees C at the patient's side and 33 degrees C on the patient's skin. ⋯ It should be remembered that the flow rate of Excelfuser is 30% greater at 33 degrees C than the inscribed value, because this calibration temperature of 22 degrees C (a new type calibrated at 32 degrees C will come to the market soon) is about 10 degrees C lower than that of others. In critical patient care we should watch the temperature of the flow controller. Additionally, according to our viscosity measurement study, we conclude that temperature depended flow rate changes are related not to the inner diameter of the flow controller, but to the viscosity of local anesthetics.
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We investigated the effects of bicarbonated Ringer's solution (BR) on arterial blood acid-base balance, and compared these with the effects of lactated Ringer's solution (LR) and acetated Ringer's solution (AR) in rats in hemorrhagic shock. Rats underwent 70% reduction of hepatic blood flow and blood shedding of 1.5% of body weight. Each solution was infused through the femoral vein at a rate of shed blood volume x 8.hr-1 for 30 min under urethane anaesthesia. ⋯ These parameters improved significantly in the BR group compared with those in the LR group. However, the LR group showed the lowest blood pH and the highest plasma lactate concentration among the groups. These results suggest that BR has superior effects on the arterial blood acid-base balance and glucose metabolism in rats in hemorrhagic shock and with hepatic dysfunction.