Masui. The Japanese journal of anesthesiology
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Comparative Study
[Effects of postoperative continuous epidural analgesia after laparoscopy-assisted colectomy].
This study was conducted to evaluate the effects of continuous epidural analgesia on the postoperative pain and the early recovery after laparoscopy-assisted colectomy (LAC). ⋯ These results show that postoperative continuous epidural analgesia is effective for postoperative pain relief in patients after laparoscopy-assisted colectomy.
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The level of arterial carbon dioxide partial tension (PaCO2) is a sine qua non for the determination of the adequacy of ventilation. The aim of this study was to assess the usefulness of SenTec Digital Monitor System in measuring transcutaneous arterial carbon dioxide partial tension (PCO2) non-invasively for the management of chronic respiratory failure. ⋯ SenTec Digital Monitor System enables non-invasive and reliable trend monitoring of PCO2 levels in patients with chronic respiratory failure.
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Case Reports
[Hypoxemia during cesarean section due to massive pleural effusion in a patient with preeclampsia].
We report hypoxemia during cesarean section in a 33-year-old woman with preeclampsia. She developed generalized body weight increase, severe proteinuria and decrease of platelets at week 33 of gestation. Cesarean section was scheduled under general anesthesia. ⋯ Massive left pleural effusion was detected and chest drainage was performed, and oxygenation was improved. Accumulation of pleural effusion tends to be over-looked because many parturients with pleural effusion do not complain of dyspnea. Physicians should pay attention to pleural effusion in parturients, especially those with risk factors such as preeclampsia, generalized body weight increase and administration of beta stimulant.
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Stiff-person syndrome is a rare disease characterized by muscle rigidity and painful spasms in the axial and limb muscles. The authors reported here a case of an axilally lymphadenectomy in a 46-year-old woman with stiff-person syndrome. With train of four ratio (TOFR) monitoring at the ulnar nerve, general anesthesia was induced and maintained with fentanyl, vecuronium and propofol with target controlled infusion. ⋯ Ten minutes after the operation, she was fully awake and train of four ratio recovered to 95%, and extubated uneventfully. We chose propofol, because of previous reports about prolonged hypotonicity by interaction of baclofen and isoflurane. Preoperative good symptom control, choice of total intravenous anesthesia (TIVA), and application of the electrical nerve stimulator prevented postoperative hypotonia and resulted in safe anesthetic management.
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A 65-year-old man underwent transversal colectomy for colon cancer under combined epidural and general anesthesia. On the 1st postoperative day, he developed consciousness loss and low SpO2 (< 90%) after walking, and pulmonary embolism was diagnosed by CT-scan and pulmonary scintigraphy. His consciousness and hemodynamic state recovered, and anticoagulation therapy was started after extraction of the epidural catheter. ⋯ The day after laminectomy, injection of heparin was started and 1 g x day(-1) of methylpredonisolone administered for 3 days. His paraplegia did not improve after the laminectomy. We discussed about pulmonary embolism and epidural hematoma.