Masui. The Japanese journal of anesthesiology
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Huge laryngeal cyst is rare, but may cause difficulty or inability in tracheal intubation during induction of general anesthesia. A 69-year-old patient was scheduled for laryngomicroscopic cystectomy. In this patient, we examined two methods of oro-tracheal intubation either with rigid laryngoscopy or flexible fiberscopy using transnasal fiberoptic monitoring. ⋯ Postoperative respiratory management under intubating state was necessary because of bleeding, airway edema, and deviation of the larynx after tumor resection. We reported anesthetic management of a patient with epiglottis gigantic cyst occupying the laryngopharyngeal airway. It is a rare tumor leading to difficulty of induction of anesthesia and necessitating postoperative intubated respiratory care.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Patient-controlled epidural analgesia with bupivacaine and fentanyl suppresses postoperative delirium following hepatectomy].
Postoperative delirium occurs frequently following major surgery, especially after hepatectomy. We hypothesized that better methods of postoperative pain control would decrease postoperative delirium. To clarify the magnitude of postoperative pain and incidence of postoperative delirium in hepatectomy patients, subjects received patient-controlled epidural analgesia (PCEA) using bupivacaine and fentanyl (Group P), or continuous epidural mepivacaine (Group E) following intraoperative epidural administration of morphine. ⋯ Moreover, less amount of antipsychotic drugs was given in Group P than in Group E. These results suggest that the better pain relief and patient satisfaction provided by PCEA contributed to a decrease in the incidence of delirium, because of continuous opioid administration and patient-control analgesia. We concluded that PCEA with bupivacaine and fentanyl can limit postoperative delirium following hepatectomy.
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The spread and time to two-segment regression of spinal anesthesia with 0.25% hyperbaric bupivacaine 2.0 ml (5 mg) were studied clinically in 20 patients for elective lower extremity, urological or gynecological surgery. Lumbar puncture was performed at the L 3-4 interspace with the patient in horizontal lateral decubitus positions using a 25-G Quincke needle. After injection of the local anesthetic solution at the rate of 0.2 ml.sec-1, the patient was placed immediately in supine position. ⋯ Maximum sensory block level was Th 10.6 +/- 2.3, and time to two-segment regression was 51.5 +/- 14.6 min. Complete motor block was observed in three out of twenty patients (15%). These results indicate that spinal anesthesia with 0.25% hyperbaric bupivacaine is useful for a short case, which dose not require motor block or is performed as day-care surgery.
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Randomized Controlled Trial Clinical Trial
[The effect of intravenous patient controlled analgesia on activities of daily life and medical expense after thoracotomy].
We investigated the efficacy of postoperative intravenous patient controlled analgesia (i.v.-PCA) combined with continuous epidural analgesia (CEA) after thoracotomy. One hundred and eight patients receiving postoperative CEA were randomly divided into two groups; the i.v.-PCA (+) group who received i.v.-PCA combined with CEA and the i.v.-PCA (-) group who did not receive i.v.-PCA. Pain score (100 mm visual analogue scale; VAS) at 24 h and 48 h, postoperative complications, activities of daily life (ADL), the length of hospital stay and medical expense were compared. ⋯ The i.v.-PCA (+) group could recover ADL more quickly and had better analgesic state compared with the i.v.-PCA (-) group. The incidence of postoperative complications was lower in the i.v.-PCA (+) group compared with the i.v.-PCA (-) group. It was concluded that the i.v.-PCA combined with CEA had the desirable effects on postoperative analgesia and recovery of postoperative ADL.
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Randomized Controlled Trial Clinical Trial
[The effect of sedation with propofol and fentanyl during epidural catheter insertion on intraoperative temperatures].
General anesthesia inhibits thermoregulation by suppressing tonic vasoconstriction and facilitates a core-to-peripheral redistribution of body heat, which is the major cause of core hypothermia during the first hour of anesthesia. We randomly assigned 16 patients to two groups; 1) patients who received fentanyl (1 microgram.kg-1, i.v.) and propofol (1.5 mg.kg-1.h-1) during insertion of epidural catheters (P group), and 2) no drug (control) group (C group). ⋯ One hour after induction of anesthesia, Ttym of P group was significantly higher than C group. We can conclude that a sedative dose of propofol and fentanyl before induction of general anesthesia inhibits redistribution hypothermia during general anesthesia.