Masui. The Japanese journal of anesthesiology
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A 65-year-old female with pulmonary tuberculosis and systemic sarcoidosis developed sudden cardiac arrest after the use of bone cement in cementedendoprosthesis of the femoral head. Cardiac arrest was difficult to manage with ordinary CPR and PCPS was immediately instituted. ⋯ The patient required ventilatory support over next 7 days, but survived without neurological sequelae. When anesthetizing an elderly patient with preexisting cardiopulmonary disease for cementedendoprosthesis, PCPS should be considered in case of cardiac arrest due to the use of bone cement.
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Randomized Controlled Trial Clinical Trial
[The effect of epidural saline injection on analgesic level during combined spinal and epidural anesthesia].
The purpose of this study is to clarify the volume effect of epidural saline injection 20 min after spinal anesthesia. Thirty patients undergoing combined spinal and epidural anesthesia for orthopedic surgery were randomly divided into two groups: a control group (n = 15) and a saline group (n = 15). In the control group, 2% lidocaine 3 ml with 0.4% tetracaine was injected into the subarachnoid space from L 4-5 interspace using Durasafe (Becton Dickinson, USA) and saline was not injected into the epidural space. ⋯ However, the levels of analgesia 3, 5, 10, 40 and 100 min after epidural saline injection in the saline group were significantly higher than those in the control group (P < 0.05). The highest analgesic level was obtained 10 min after epidural saline injection and reached to T 4.3 +/- 1.1. In conclusion, epidural saline injection increases the analgesic level 20 min after spinal anesthesia because of the volume effect.
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Randomized Controlled Trial Multicenter Study Clinical Trial
[Total intravenous anesthesia with propofol is advantageous than thiopental-sevoflurane anesthesia in the recovery phase].
A randomized, prospective and multi-institutional study was performed to investigate whether different anesthetic methods affected differently the quality of recovery from anesthesia. Two hundred and eleven patients were allocated to one of two groups; total intravenous anesthesia (TIVA) with propofol and fentanyl (group P, n = 107) and general anesthesia with thiopental, sevoflurane and nitrous oxide (group TS, n = 104). ⋯ The postoperative incidence of vomiting was not significantly different between the two groups (3.7% in the group P and 9.6% in the group TS), but the postoperative incidences of nausea and headache were significantly lower in the group P compared with the group TS (10.3%, 17.8%, respectively in the group P and 34.6%, 29.8%, respectively in the group TS). We conclude that TIVA with propofol is advantageous than thiopental-sevoflurane anesthesia in the recovery phase.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Sedative and hypnotic properties of propofol during epidural or spinal anesthesia].
The sedative and hypnotic properties of propofol were studied in 40 patients undergoing elective gynecologic or orthopedic surgery using epidural (epidural group, n = 20) or spinal (spinal group, n = 20) anesthesia. Patients were given a bolus dose of 1 mg.kg-1 immediately followed by a continuous infusion of 4 mg.kg-1.h-1 of propofol after epidural or spinal anesthesia. The patients were asked to open their eyes on command at 10-sec interval from the end of the bolus infusion of propofol. ⋯ Oxygen inhalation was needed in 75% of the patients in the epidural group and 100% in the spinal group. These results indicate that bolus and continuous infusion of propofol produces rapid induction, deep level of sedation, and rapid recovery during epidural or spinal anesthesia. However, respiratory depression appeared at this infusion rate during regional anesthesia.
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We experienced a case of difficult tracheal intubation in a 15-year-old boy with von Recklinghausen disease scheduled for resection of a right neck tumor. His scoliosis made it difficult to intubate and to manage airway because he easily developed dyspnea. We tried nasotracheal intubation with the patient awake under sedation using a bronchofiberscope, but we found an unexpected tumor jeopardizing his airway patency near his vocal cord. Preoperative examination of a tumor in the airway is essential in the anesthetic management of the patients with von Recklinghausen disease.