Masui. The Japanese journal of anesthesiology
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The influence of surgery and anesthesia on aspects of malignant tumor has received considerable attention in recent years. It is suggested that in vitro studies, clinically available anesthetics, such as intravenous anesthetics, local anesthetics and opioids have, more or less, possible antitumor potential against human malignant tumor cells. ⋯ Moreover, animal studies indicate that the addition of spinal block and optimum postoperative analgesia independently reduce the metastatic burden by blocking the stress response under inhalational anesthesia alone. Considering inconclusive results, especially in human, about evaluating the influence of anesthetics on malignant tumor, further studies in basic and clinical settings are required to study the effects of anesthetics on malignant tumor.
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Propofol target-controlled infusion (TCI) is now commonly used for induction and maintenance of anesthesia. In this study, we measured the propofol plasma concentrations in obese patients in order to test our hypothesis that propofol TCI is reliable for use in obese patients. ⋯ We conclude that propofol TCI is a reliable method for maintaining anesthesia even in obese patients. At emergence, however, the data suggested that the plasma concentrations might be lower than the estimated values in obese patients.
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Cleveland Clinic Labor and Delivery Unit is a syntactical delivery facility and comprised of 16 delivery rooms, 3 operating rooms, 3 triage rooms, and 1 recovery room that has a capacity of 6 beds, 43 postpartum rooms, 2 nurseries, and 1 neonatal intensive care unit (NICU). Cleveland Clinic Labor and Delivery Unit (LDU) had 3,691 delivery cases in 2007. The ratio of neuraxial analgesia (NA) during labor is 84.2% (2,348/ 2,787), using epidural anesthesia or combined spinalepidural anesthesia (CSEA). This article introduces the obstetrical (OB) anesthesia practice at the Cleveland Clinic and our novel anesthetic regime as typical of one typical busy day.
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Case Reports
[Suspected case of peripartum cardiomyopathy developed during elective cesarean section].
A 35-year-old primigravida with twin gestation was admitted for elective cesarean section. She had no preoperative systemic diseases including heart disease. At 37 weeks of gestation, elective cesarean section was performed under combined spinal-epidural anesthesia. ⋯ Peripartum cardiomyopathy was strongly suspected. Symptoms of heart failure were alleviated by water restriction and furosemide by the 9th POD. The EF increased to 50% on the 15th POD.
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Case Reports
[Difficult tracheal intubation using airway scope in a pediatric patient with Hunter syndrome].
Hunter syndrome, manifested by mucopolysaccharidosis II (MPS II), is a hereditary disorder caused by accumulation of glycosaminoglycans. An important issue in regard to anesthesia in affected individuals is airway management, because of gargoylism. An 8-year-old boy with MPS II was scheduled for adenotonsillectomy. ⋯ Finally, we inserted a stylet into the tracheal tube attached to the blade of the AWS and successful tracheal intubation was accomplished. The operation was completed uneventfully and the patient entered the ICU with his trachea intubated, because of pharyngeal and laryngeal edema. Although useful for difficult airway management, tracheal intubation with the AWS may be difficult when used in patients with a narrow oral cavity or small tracheal tube.