Masui. The Japanese journal of anesthesiology
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Epidural anesthesia in pediatric patients has become popular, and some useful techniques have been introduced. We use the pressure-guided method to identify the epidural space. This method enables us to visualize, on the monitor, the pressure change as the needle advances. ⋯ In the first 10 months after I started working as a resident in anesthesia, I performed 16 pediatric epidural anesthesias successfully under the direction of the anesthetic specialist. I would like to emphasize that I was able to perform epidural anesthesia safely at the thoracic level (T 11 x 12) even in the newborn (body weight 3400 g). The pressure-guided method enables us, even a new resident, to accomplish epidural anesthesia at thoracic level in newborn.
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Randomized Controlled Trial Clinical Trial
[Pretreatment with lidocaine accelerates onset of vecuronium-induced neuromuscular blockade].
The purpose of this study was to investigate the effect of pre-treatment with lidocaine on the onset of vecuronium-induced neuromuscular block in a randomized, double-blinded trial. Thirty-one patients were randomly allocated to one of two groups according to the agents administrated 3 min prior to vecuronium injection; Group C, normal saline 0.75 ml.kg-1 and Group L, 2% lidocaine 1.5 mg.kg-1. Anesthesia was induced with propofol 1.5 mg.kg-1 followed by continuous infusion at 8 mg.kg-1.hr-1. ⋯ Changes in SBP, DBP and HR did not differ between Group L and Group C. The mechanisms by which lidocaine reduced the time to onset of neuromuscular block caused by vecuronium could not be clarified from our study, but this may be related to pre- and post-junctional effects of lidocaine at neuromuscular junction. In conclusion, administration of lidocaine prior to tracheal intubation reduces the time to onset of neuromuscular block caused by vecuronium, but does not attenuate changes in blood pressure and heart rate caused by tracheal intubation.
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Randomized Controlled Trial Clinical Trial
[Efficacy of bispectral index monitoring in improving anesthetic management, economics, and use of the operating theater].
This study was designed to assess the efficacy of bispectral index (BIS) monitoring in reducing the amount of volatile anesthetics used and improving recovery profiles. Sixty patients (ASA physical status 1 or 2) undergoing various surgical procedures under sevoflurane/nitrous oxide anesthesia were studied. The patients were randomly assigned to two groups of which anesthesia was carried out with (BIS group) or without (control group) monitoring BIS, and in the latter, anesthesiologist was blinded to the BIS values. ⋯ Compared with control group, the patients in BIS group were extubated earlier and became eligible for discharge earlier from recovery room than control group. There was no significant difference in the incidence of intraoperative complications between the groups. Titrating sevoflurane concentration with BIS monitoring during anesthesia decreased anesthetic consumption and improved recovery compared with standard clinical practice.
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Case Reports
[A case report of hemidiaphragmatic paresis caused by interscalene brachial plexus block].
A 76-yr-old woman was scheduled for left upper extremity orthopedic procedure. Preoperative examinations were within normal limits except forced vital capacity. Interscalene brachial plexus block with 0.25% bupivacaine 15 ml, was performed under general anesthesia. ⋯ A chest X-ray demonstrated the elevation of hemidiaphragm. She was diagnosed as ipsilateral hemidiaphragmatic paresis, treated with oxygen inhalation under deep breathing for approximately one hour, and then transferred to the common ward. We conclude that respiratory movement should be carefully observed following interscalene brachial plexus block especially in geriatric patients.
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We report a case of malignant goiter with severe tracheal stenosis. The patient was a 61-year-old female, who had orthopnea on admission. Radiological examinations revealed a tracheal stenosis extending from 4.5 cm to 8 cm below the glottis; the smallest caliber being 5 mm. ⋯ Unexpectedly, the tube could be advanced through the stenosis without resistance. After induction of general anesthesia, the patient was placed in a supine position, and a tracheotomy was performed. This case demonstrates that, while intubation of the trachea through a stenosis is sometimes dangerous, it may be indicated when the inner surface of the trachea is intact and a tube with an inner diameter greater than 5 mm can then be placed.