Masui. The Japanese journal of anesthesiology
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It is important "to obtain cooperation of a patient" and "to practice efficiently" in paramedic intubation practice. In our hospital, we distribute a pamphlet at the time of informed consent acquisition and we present a letter of thanks after the practice. ⋯ By the time 5 paramedics have completed the practice period, the average time is 36.4 days, the rate of patient consent is 94% and the successful rate of intubation is 99%. The paramedic intubation practice is implemented relatively smoothly.
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Applying cricoid pressure is a simple and effective means of preventing aspiration of gastric juice and content. This procedure prevents a possible reflux by compressing the esophagus between the cricoid cartilage and the cervical vertebral bodies. Recent studies recommend a pressure of 30-40 N. The present study was undertaken to determine whether with education and practice, anesthesia assisitants could be taught a recommended cricoid pressure and retain this skill. ⋯ This model represents an easy and practical means of training the application of the optimal level cricoid pressure but the training should be continued.
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We experienced a case of intractable lower limb pain successfuly treated by spinal cord stimulation with an electrode inserted retrogradely. The patient is a 32 year-old-man suffering from intractable lower limb pain on the area innervated by the sciatic nerve from unidentified cause for about 4 years. We tried various treatments such as epidural block, S 1 nerve-root block including thermocoagulation technique, opiate. ⋯ Therefore, 6 years after the onset of the symptom, we tried to stimulate electrically the nerve with an electrode inserted retrogradely. This method of spinal cord stimulation produced enough pain reduction. The method of retrograde insertion of an electrode for spinal cord stimulation seems to be a good way to treat intractable pain of the area innervated by a single spinal nerve.
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Case Reports
[Powder-induced anaphylactic shock following use of powdered latex gloves during gynecological open laparotomy].
A 42-year-old woman with hysteromyoma underwent total abdominal hysterectomy under general and epidural anesthesia. Three years before, she had undergone resection of lipoma on her left shoulder under local anesthesia uneventfully. She had no previous history of hypersensitivity. ⋯ Latex allergy should be suspected if an anaphylactic reaction or shock accompanied by circulatory collapse, respiratory failure, and skin symptoms of unknown origin occurs during surgery. As women more often come into contact with household articles containing latex, we suspect that women are prone to developing sensitivity towards latex. We recommend that powder-free or latex-free surgical gloves should be available not only for patients with a high risk of developing latex allergy, but also for patients indicated for gynecological open laparotomy.
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There is no useful predictor of treatment preventing progress from hemorrhagic shock to systemic inflammatory response syndrome or disseminated intravascular coagulation. Recent reports have shown that blood lactate levels could be related to outcome of critically ill patients including those with septic shock. ⋯ Blood lactate concentrations and especially their time courses have a strong relation with survival from hemorrhagic shock and can be reliable clinical predictors of therapy.