Masui. The Japanese journal of anesthesiology
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Case Reports
[Tracheal intubation for emergent tracheostomy in a patient complicated with tracheal stenosis].
We report the management of anesthesia for emergent tracheostomy in a patient with severe tracheal stenosis. A 63-year-old male was scheduled for an emergency tracheostomy for severe tracheal stenosis due to the invasion of a thyroid cancer. A preoperative neck CT revealed the tracheal stenosis, extending from 1-2 cm below the vocal cord to the upper end of the sternum. ⋯ General anesthesia with endotracheal intubation was considered necessary to provide an open airway during tracheostomy. Anesthesia was induced with thiopental, and a 6.0 mm endotracheal tube with cuff was successfully introduced with a balloon introducer (AIRGUID E) using suxamethonium. We were able to perform tracheostomy uneventfully.
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Case Reports
[Management of difficult airway during induction of anesthesia in a patient with Hallermann-Streiff syndrome].
An 18-year-old female with Hallermann-Streiff syndrome underwent the fixation of prolapsus recti. She had significant microgenia, mental retardation and pharyngeal airway stenosis. During induction of anesthesia with halothane and nitrous oxide, severe upper airway obstruction and respiratory depression occurred. ⋯ Lowering anesthetic level restored her spontaneous breathing and airway patency. Although the direct laryngoscopic view under light anesthesia with halothane was limited to the epiglottic tip, blind orotracheal intubation using stylet was accomplish after several attempts. At the end of anesthesia, the tracheal tube was extubated after the patient had become fully awake and had recovered completely from neuromuscular blockade monitored by electromyography.
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Clinical Trial
[Lidocaine tape (Penles--a dressing tape based on 60% lidocaine--) reduces the pain of postherpetic neuralgia].
The treatment of postherpetic neuralgia (PHN) by topical administration of local anesthetics has a number of drawbacks. Lidocaine tape (Penles) is a 15 cm2 dressing tape based on 60% lidocaine used to anesthetize skin when an intravenous catheter is inserted. This study aims to evaluate the analgesic efficacy of lidocaine tape in patients with PHN by comparing the results with those of surgical drape (Tegaderm). ⋯ Pain score was reduced at measurements taken starting from 1 hour after lidocaine tape application (P < 0.05). Lidocaine tape induced minor side-effects, erythema in a patient and increase in pain in another patient. In conclusion, lidocaine tape is effective for relief of PHN.
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We studied the neurotoxic effect of lidocaine at different concentrations on the desheathed rabbit vagus nerve by measuring the amplitudes of evoked compound action potentials and the histological changes of the nerve by means of the electron microscopy after incubation in lidocaine-Ringer's bicarbonate (RB) solution. The following results were obtained. 1) Minimum concentrations of lidocaine for producing complete conduction block (minimum blocking concentration, MBC) were 0.02% for A beta and A delta fibers, and 0.03% for C fibers. 2) Irreversible conduction blocks of compound action potentials were observed in relation with lidocaine concentrations and the duration of incubation: e.g. 0.5% for 2 hours incubation was equivalent to the block with 1% for 1 hour. 3) Degenerative change of axons was revealed morphologically in the preparations exposed to 2% or a higher concentration of lidocaine. 4) Risk ratio, which means a numerical value calculated as clinical concentration/irreversible concentration with 2 hr exposure, was similar to other local anesthetics except dibucaine HCl, which shows an higher risk ratio. However, it should be noted that lidocaine has an risk of producing irreversible changes in nerve fibers, when applied to the nervous tissue at higher concentrations for longer durations.