Masui. The Japanese journal of anesthesiology
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Case Reports
[Two cases of epidural neulolysis using ethyl alcohol and histopathologic changes in the spinal cord].
We report two cases of cancer pain treated with transcatheter thoracic epidural neurolysis using ethyl alcohol, and epidural histopathologic changes in the spinal cord observed in one of the patients. Case 1: A 59-year-old woman complained of intractable right thoracic back pain due to mediastinal osteo-sarcoma. After obtaining pain relief by epidural block using local anesthetics, we did transcatheter thoracic epidural alcohol block using 2-4 ml of 75-100% ethyl alcohol for three times. ⋯ We performed twice transcatheter thoracic epidural neurolysis using 2-3 ml of 75% ethyl alcohol. Her VAS score decreased from 7/10 to 3/10 and the pain relief was maintained until her death 2.5 months after the neurolysis. Motor palalysis was not observed in both cases.
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We describe a case of Freeman-Sheldon syndrome that presented some problems for anesthetic management. A 2-yr-old girl required orthopedic surgery for the bilateral lower extremities. Anesthesia was induced via a mask with oxygen (2 l.min-1), nitrous oxide (4 l.min-1) and sevoflurane (approximately 5%). ⋯ Combined caudal epidural block was, however, avoided because spina bifida occulta was suspected. Spina bifida occulta was revealed postoperatively by X-ray. For anesthetic management of a patient with Freeman-Sheldon syndrome, the spine should be evaluated preoperatively when performing epidural/spinal anesthesia.
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The effects of vasodilators and anesthetics on the circulatory and metabolic conditions were compared during hypotensive anesthesia. Forty two subjects undergoing tympanoplasty were divided into 6 groups: PG + S: N2O/sevoflurane with prostaglandinE1 (PG), TM + S: N2O/sevoflurane with trimetaphan (TM), NG + S: N2O/sevoflurane with trinitoglycerin (NG), PG + P: N2O/propofol with PGE1, TM + P: N2O/propofol with TM, NG + P: N2O/propofol with NG. ⋯ Although pHi decreased slightly during hypotensive anesthesia in all groups, pHi was not decreased below the critical level of 7.30. The circulatory and metabolic conditions under induced hypotensive anesthesia were influenced by both vasodilators and anesthetics, and the dosage of vasodilator to decrease arterial blood pressure was dependent on the anesthetic used simultaneously.
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Effects of autologous blood transfusion and isovolemic colloids transfusion on hemorrhagic shock model in rats were investigated. The hemorrhagic shock model in rats was prepared by rapid exsanguination and the blood pressure was kept at 40 mmHg for 30 min. As a marker of hemodynamic change, the blood gas analysis was performed, and the tissue oxygen pressure of the liver and the spleen was also measured. ⋯ However, the liver PtO2 did not show any changes during hemorrhagic shock, although the spleen PtO2 tended to decrease. These changes seen at the hemorrhagic shock were equally restored after the treatment with either autologous blood transfusion or isovolemic colloids transfusion. These results indicate that either autologous blood transfusion or isovolemic colloids transfusion can be useful for the therapy of severe hemorrhagic shock, and the NO production in the liver can participate in the maintenance of homeostasis under hemorrhagic shock.