Masui. The Japanese journal of anesthesiology
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This is a report of a retained epidural catheter segment after placement of 20-G polyethylene catheter (Hakko Medical) through 17-G Tuohy needle and 25-G spinal needle (Top Company) for a patient receiving combined spinal-epidural anesthesia. Retained catheter fragment (approximately 10.6 cm) was removed easily with small incision under local anesthesia. Electron microscopic findings of the catheter showed that the catheter might have been traumatized by the Tuohy needle through which the catheter was placed or by the spinal needle for intrathecal anesthesia, resulting in having been sheared off.
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A 67-year-old male patient with chronic tympanitis was scheduled for elective tympanoplasty. Propofol and fentanyl were used for induction and the patient was ventilated with sevoflurane, oxygen and nitrous oxide for general anesthesia. ⋯ The surgery was discontinued for the safety of the patient, in spite of the recovery of ventilation with a facemask. It is suspected that the ventilatory difficulty was caused by the following reasons; first, the laryngeal mask airway was shifted by change of the body position, second, the mask tip was inserted at the inlet of the larynx because the internal cuff pressure had risen with nitrous oxide.
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Case Reports
[Total intravenous anesthesia with propofol, ketamine, and fentanyl (PFK) for a patient with mitochondrial myopathy].
Anesthetic management for a patient with mitochondrial myopathy is described. A 57 year-old-female underwent laparoscopic cholecystectomy for cholelithiasis. The patient had been diagnosed as having mitochondrial myopathy from muscle biopsy. ⋯ Her reaction to vecuronium bromide was within normal limits evaluated with a neuromuscular activity parameter, train-of-four ratio. No serious acidosis, hyperlactemia, hypothermia, nor prolonged recovery from the anesthesia was observed. As inhaled anesthetics may be contraindicated for mitochondrial myopathy, and nitrous oxide for laparoscopic surgery is relative contraindication, total intravenous anesthesia with muscle relaxant titration is appropriate for laparoscopic surgery for patients with mitochondrial myopathy.
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We experienced anesthetic management for a patient with platypnea-orthodeoxia syndrome. This syndrome is relatively uncommon and accompanies dyspnea and hypoxemia on changing to a sitting or standing from recumbent position. A 75-year-old man with the syndrome underwent atrial septal defect closure on cardiopulmonary bypass. ⋯ The perioperative and postoperative course was uneventful, except for hypoxemia during induction. Although the exact mechanisms of platypneaorthodeoxia remains to be solved, right-to-left shunt by an anatomical abnormality and by change of the atrial septum is considered one of the hypoxic mechanisms. We suggest that it is necessary to prevent right-to-left shunt and hypoxemia in anesthetic management of a patient with platypneaorthodeoxia syndrome.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Comparison of 8 mg and 10 mg hyperbaric bupivacaine during spinal anesthesia for cesarean section in Japanese parturients].
Hypotension after spinal anesthesia for cesarean section is common and may result in serious complications despite the use of uterine displacement and volume preloading. Adequate amount of hyperbaric bupivacaine for Japanese parturients whose frames are generally smaller than those of Caucasian counterparts have not yet been examined. We compared the analgesic efficacy and the incidence of hypotension with 8 mg versus 10 mg hyperbaric bupivacaine during spinal anesthesia for cesarean section in Japanese parturients. ⋯ Injection of 8 mg hyperbaric bupivacaine is preferable than 10 mg in spinal anesthesia for cesarean section to obtain adequate analgesic efficacy and to avoid maternal hypotension.