Masui. The Japanese journal of anesthesiology
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A 41-year-old male patient with well-controlled hypertension underwent a partial nephrectomy under total intravenous anesthesia with propofol, fentanyl and ketamine. To avoid allogeneic blood transfusion, preoperative autologous blood donation (400 g) a week before the surgery and acute normovolemic hemodilution (800 g) after induction of anesthesia were performed. As surgical blood loss was more than 4000 g, blood hemoglobin (Hb) level decreased to 6.4 g.dl-1. ⋯ In addition, any postoperative complications by low Hb level were not recognized so far. This case suggests that combination of autologous transfusion techniques may be effective to avoid allogeneic blood transfusion even against massive hemorrhage. However, to avoid disadvantage of these technique, we should always evaluate preoperative patient conditions.
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Randomized Controlled Trial Clinical Trial
[The effect of continuous intra-articular and intra-bursal infusion of lidocaine on postoperative pain following shoulder arthroscopic surgery].
We evaluated the effects of continuous intra-articular and intra-bursal infusion of lidocaine on postoperative pain following shoulder arthroscopic surgery. Forty-one ASA I-II patients scheduled for shoulder arthroscopic surgery, were allocated into following four groups. The patients, after intra-articular arthroscopic surgery, either received intra-articular lidocaine (Group I, n = 10) or did not (Group III, n = 10). ⋯ The VAS scores and the number of analgesic requests were significantly lower (P < 0.05) in Group I than Group III, and in Group II than Group IV throughout the postoperative observation period. No adverse effects were observed during this study. We conclude that continuous intra-articular and intra-bursal infusion of lidocaine provides effective postoperative pain relief for shoulder arthroscopic surgery.
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We evaluated the validity of Cole's formula (tube size = 0.25 x age + 4) for the estimation of uncuffed endotracheal tube size, and devised new formula with a statistical method on the basis of the ages of 217 pediatric patients with congenital heart disease. The sizes of the tubes actually used for these patients were 0.5 mm or larger than those estimated by Cole's formula in 29% of patients with congenital heart disease. ⋯ The regression formula representing the relationship between the tube size and age was "tube size = 0.316 x age + 4.135". In conclusion, tube size estimated by Cole's formula tends to be smaller than practically appropriate tube size for pediatric cardiac anesthesia, and therefore we suggest new formula to estimate the tube size.
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We present a case of a 27-year-old man with gunshot injury in the neck and the chest. On admission, he had an entry wound in the neck and his chest radiograph showed left hemopneumothorax. Nasal endotracheal intubation and chest drainage were immediately performed. ⋯ OLV was successfully performed by blocking the left main trunchus with a 7 Fr Fogarty catheter placed under fiberscopic monitoring. The patient recovered without any serious complications. Prompt and proper airway management is required in gun shot injury of the neck and chest.
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We report that Trachlight-guided nasotracheal intubation might be achieved successfully and traumatically without removal of a stiff internal stylet. Endotracheal tube was mounted on a Trachlight with the stylet in position and bent to form a less sharp curvature than a right angle, namely 40-60 degree, at 7 cm proximal to the endotracheal tube tip. ⋯ The tracheas were successfully intubated in 89% of patients. We suggest that Trachlight-guided nasotracheal intubation could be clinically feasible without traumatic complication when applied with a stiff stylet in position and this approach is a useful method for nasal intubation.