Masui. The Japanese journal of anesthesiology
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A 71-year-old-man with pneumothorax was scheduled for a video-assisted-thoracic-surgery. He had received subtotal resection of the mandible and was anticipated to have difficult airway. Anesthesia was induced by fentanyl, midazolam, and maintained by 0.4% isoflurane in pure oxygen. ⋯ Then, a Tracheal Tube Guide was inserted through the single lumen tube. After the tube had been removed, a double lumen tube was advanced into the trachea guided by the Tracheal Tube Guide. During this procedure oxygen saturation was maintained at 100%.
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A 75-year-old woman with breast cancer complicated with tetanus was scheduled for mastectomy. Since severe bradycardia (17 beats.min-1) was detected by preoperative Holter monitoring, a temporary pacing catheter was inserted. ⋯ Her perioperative heart rate was 80-105 beats.min-1 and the rhythm was sinus. There was no marked perioperative cardiovascular derangement.
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Randomized Controlled Trial Clinical Trial
[Relationship between minimum alveolar concentration and electroencephalographic bispectral index as well as spectral edge frequency 95 during isoflurane/epidural or sevoflurane/epidural anesthesia].
To investigate the relationship between minimum alveolar concentration (MAC) and electroencephalographic variables, we measured the bispectral index (BIS) and the spectral edge frequency 95 (SEF 95) in 17 patients undergoing elective surgery during isoflurane/epidural (n = 8) or sevoflurane/epidural (n = 9) anesthesia. Patients received 2.0 MAC end-tidal concentrations of isoflurane or sevoflurane, and the BIS and the SEF 95 were recorded after 15 min of an unchanged end-tidal concentration. The concentration of the inhalational agent was decreased to 1.2 MAC, and measurements were repeated again. ⋯ There were significant differences in the BIS and the SEF 95 at 2.0 MAC between isoflurane and sevoflurane groups. In contrast, the BIS and the SEF 95 showed no difference at 1.2 MAC between the groups. These findings suggest that different inhalational anesthetics may have different effects on the BIS and the SEF 95.
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Randomized Controlled Trial Clinical Trial
[The effects of conscious sedation by propofol on respiration during abdominal hysterectomy under spinal anesthesia].
The effects of conscious sedation by propofol on respiration were studied in 28 patients undergoing abdominal hysterectomy under spinal anesthesia. The patients were randomly assigned to receive conscious sedation by propofol (Group P, n = 20) or no sedation (Group C, n = 8). After a satisfactory level of analgesia had been achieved, a loading dose of propofol, 0.2 mg.kg-1 was administered every minute in Group P until patients exhibited spontaneous eye closure or nystagmus. ⋯ Compared with Group C, the respiratory depression was less in Group P; SpO2 was significantly higher at 25 min after spinal tap and PETCO2 was significantly lower at 30 and 50 min after spinal tap in Group P. A score of patient satisfaction was significantly higher in Group P. Conscious sedation by propofol is a safe and useful supplement to spinal anesthesia for abdominal hysterectomy.
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Comparative Study Clinical Trial
[The techniques to identify the epidural space do not influence the success rate in combined spinal-epidural anesthesia: a comparison between loss-of-resistance and hanging-drop].
The hanging-drop (HD) technique has been attributed to a negative epidural pressure induced by making a tent of the dura by the Tuohy needle. We, therefore, hypothesized that the HD technique would result in more successful intrathecal placement of the spinal needle in combined spinal-epidural anesthesia (CSEA) compared with the loss-of-resistance (LR). Seventy patients received CSEA using the needle-through-needle method with a spinal needle extending 9 mm beyond the Tuohy needle. ⋯ Failure to obtain CSF after 3 attempts was not significantly different between the two techniques; 26% and 31% in HD and LR, respectively. In conclusion, there was no advantage of the HD technique for obtaining CSF in CESA compared with the LR. It seems that spinal needle length beyond the Tuohy needle should be more than 9 mm.