Masui. The Japanese journal of anesthesiology
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Epidural block is very useful in the treatment of herpetic pain and post herpetic neuralgia. However, in the elderly patients with cardiac disease or diabetes mellitus, severe cardiovascular changes may occur by epidural block. Epidural block caused severe hypotension in two elderly patients with herpetic pain and post herpetic neuralgia who had diabetes mellitus or hypertension. Continuous thoracic sympathetic ganglion block with local anesthetics through a placed catheter reduced their pain and caused almost no changes in cardiovascular system.
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Microlaryngeal surgery was performed with total intravenous anesthesia using pentazocine and propofol in 20 patients. The patients were paralyzed by suxamethonium infusion and ventilated by high frequency jet ventilation via the laryngoscope. In place of the opioid analgesics commonly used in TIVA for microlaryngeal surgery, pentazocine was given. ⋯ Average time of surgeries was 33.6 minutes. Average doses of pentazocine and suxamethonium given during surgeries were 369 m.g. and 286 m.g., respectively. This technique allowed stable anesthesia to be achieved with rapid postoperative recovery, without serious complications like intraoperative return of awareness.
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In order to evaluate cerebral oxygenation and perfusion during deep hypothermic circulatory arrest (DHCA) and selective cerebral perfusion (SCP), continuous measurement of regional cerebral oxygen saturation (rSO2) by near-infrared spectroscopy (NIRS) was performed. Two patients undergoing aortic arch surgery performed under DHCA and SCP were studied. 1) Circulatory arrest produced a continuous decrease in rSO2. Introduction of SCP increased rSO2 to even above the pre-circulatory arrest level (reperfusion hyperoxia). 2) During SCP, changes in rSO2 correlated well with the naso-pharyngeal temperature, SCP flow rate, and level of carbon-dioxide insufflation to SCP. 3) These changes in rSO2 paralleled with those of jugular venous hemoglobin saturation (SjO2) measured simultaneously, although SjO2 frequently exhibited artifacts. We conclude that rSO2 measurement may be a non-invasive and continuous measure in the evaluation of cerebral oxygenation and perfusion during DHCA and SCP.
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During perioperative period, plasminogen abnormality can result in unusual or unexplained clotting that occurs spontaneously or after minor trauma. However, there has been no report on perioperative anticoagulation therapy and monitoring in patients with hereditary plasminogen abnormality undergoing cardiac surgery. We performed a successful perioperative anticoagulation therapy and monitoring of a patient with hereditary plasminogen abnormality undergoing cardiac surgery. ⋯ When the patient was admitted to ICU, anticoagulation therapy was started immediately. During perioperative period, no episode suggesting thrombosis was observed. In conclusion, we consider that this successful anticoagulation therapy and monitoring during CPB has been achieved by use of Hepcon/HMS.
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We monitored bilateral cerebral oxygen saturation and hemoglobin index while the brain received separate perfusion for major vascular surgery. Before surgery, left cerebral oxygen saturation and hemoglobin index were within normal limits but right cerebral oxygen saturation and right hemoglobin index were low. ⋯ No paralysis or any other neurological complications occurred postoperatively. We conclude that such monitoring is useful during and after anesthesia under separate brain perfusion.