Masui. The Japanese journal of anesthesiology
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A 70-year-old man who had undergone an elective transverse colectomy developed neural injury caused by defective epidural needle. The stylet of the 17-gauge disposable Tuohy needle used consisted of two components. The tip of the stylet was made of teflon and the material of the body was steel. ⋯ The cause of the failure was finally found to be complete obstruction of the needle with a small piece torn from the stylet tip. Right femoral pain, right instep hypesthesia and muscle weakness in the right leg remained after the operation. These symptoms gradually improved and he left the hospital with slight hypesthesia remaining in his right instep 42 days after the operation.
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We describe a case of persistent left-sided superior vena cava discovered after insertion of a pulmonary artery (PA) catheter. The diagnosis was suggested by chest X-ray after PA catheter placement and was subsequently confirmed by an echocardiograph. A 68-year-old man was admitted to our ICU because of septic shock induced by MRSA enterocolitis. ⋯ A chest X-ray showed the PA catheter passing along the left border of the heart. An echocardiograph showed the PA catheter passing through the coronary sinus into the pulmonary artery. Anesthesiologists and intensivists should be aware of the occurrence of left-sided superior vena cava in order not to mistake catheters placed in it as being in the arterial circulation or malpositioned outside of the venous circulation.
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Thirty-one nurses in the surgical ward engaged in delivering postoperative analgesia using patient-controlled analgesia (PCA) were asked to complete questionnaires on postoperative analgesia and PCA. Ninety-seven per cent of respondents agreed that the postoperative analgesia is beneficial for postoperative recovery, and answered that the desirable goal in postoperative analgesia is "no pain at rest". Not only "pain at movement" or "pain on coughing", but also "decreased conscious level while analgesia is achieved" were selected as undesirable conditions during postoperative course. ⋯ In addition, 65 per cent of respondents chose PCA as a method for postoperative analgesia when they receive thoraco-abdominal surgery. On the other hand, some problems on pain management using PCA, such as taking care of patients' ambulation with carrying a PCA pump, extra time for instruction of PCA and extra support for patients' psychological state were listed. In conclusion, these results suggest that PCA is accepted as an excellent method for postoperative analgesia among our nurses in the surgical ward, and education in postoperative pain management including PCA is required in nursing school as well as after graduation.