Masui. The Japanese journal of anesthesiology
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Comparative Study
[Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone in gynecological surgery].
The authors evaluated the efficacy of a combination of dexamethasone and metoclopramide for the prophylaxis of postoperative nausea and vomiting (PONV) after gynecological abdominal surgery. ⋯ A combination of metoclopramide and dexamethasone was more effective in preventing PONV compared with metoclopramide alone.
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Comparative Study
[Comparison of the effects of sevoflurane and propofol on changes in leukocyte-count induced by surgical stress].
It is well known that surgical stress causes granulocytosis and lymphopenia. However, effects of general anesthetics on changes in leukocyte-count induced by surgical stress are not still clear. ⋯ There were significant differences in effects of sevoflurane and propofol on changes in lymphocyte-count induced by surgical stress. Results of this study imply the efficiency of propofol to prevent lymphopenia, which may play an important role in postoperative immunosuppression caused by surgical stress.
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Case Reports
[Anesthetic management of laparotomy for a patient with amyotrophic lateral sclerosis: a case report].
Amyotrophic lateral sclerosis (ALS) is a disease involving motor neurons. There are two major problems in anesthetic management for patients with motor neuron diseases; prolongation of the effect of non-depolarizing muscle relaxant, and controversy about a use of neuraxial block. We describe the anesthetic management of laparotomy for a patient with ALS by general anesthesia alone. ⋯ The patient emerged from general anesthesia smoothly, and was extubated without any complications. For the postoperative pain management, we administered opioids intravenously, providing good analgesia. The postoperative course was uneventful, and there was no exacerbation of neurological signs and symptoms of ALS.
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The Pentax-AWS videolaryngoscope (Tokyo, Japan) has been used successfully to intubate the trachea in patients with difficult airways. We report the use of the Pentax-AWS for tube exchange in a patient with difficult airway. In a 57-year-old man scheduled for laminectomy of the cervical spines, tracheal intubation of a reinforced tube was accomplished with a great difficulty. ⋯ Under the video image, the cuff of the reinforced tube was deflated, and a tube exchanger was introduced through the polyvinylchloride tube into the trachea, alongside the reinforced tube. The reinforced tube was removed, and the new tube was advanced over the exchanger into the trachea. We suggest that the Pentax-AWS is useful for tube exchange, as one can continuously confirm the entire course of exchange and can detect and rectify any possible problems, such as difficulty in advancing an endotracheal tube over the exchanger.
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Although administration of heparin is a useful method for preventing deep venous thromboembolism, one limitation is the increased risk of bleeding. In this retrospective investigation, we evaluated the effect of heparin on the activated partial thromboplastin time (APTT) in parturients who received caesarean section under combined spinal and epidural anesthesia. ⋯ Subcutaneously administered heparin, 5000 units twice daily, might have a role in preventing deep venous thromboembolism in parturients undergoing caesarean section. Strict vigilance, however, should be provided against increased bleeding associated with epidural hematoma in parturients with an indwelling epidural catheter.