Masui. The Japanese journal of anesthesiology
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Spinal anesthesia combined with fentanyl sometimes induces sedation. We previously reported that the bispectral index (BIS) value during spinal anesthesia with isobaric bupivacaine is reduced with intrathecal fentanyl but not with intravenous or epidural fentanyl. The current study investigated whether the specific gravity of bupivacaine combined with intrathecal fentanyl in spinal anesthesia for cesarean section effected the BIS values. ⋯ The BIS values in patients who received intrathecal isobaric bupivacaine with fentanyl were lower than those with intrathecal hyperbaric bupivacaine and fentanyl.
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Case Reports
[Successful fiberoptic tracheal intubation via Cobra PLA in a patient with an epiglottic tumor].
A 59-year-old woman with an epiglottic tumor was scheduled for the total removal of the mass by laryngomicrosurgery. The patient had no preoperative respiratory symptoms. ⋯ Post-extubation course was uneventful. The Cobra PLA can be a good alternative supraglottic airway device allowing easy tracheal intubation for difficult airway.
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Case Reports
[Difficult mask ventilation and tracheal intubation in a patient with Hutchinson-Gilford syndrome].
We report a case of difficult ventilation and tracheal intubation in a 18-year-old woman with Hutchinson-Gilford syndrome. She was diagnosed with osteosarcoma in the right tibia and thyroid cancer. ⋯ In the second operation, mask ventilation and tracheal intubation were easily conducted by using Berman pharyngeal airway. Berman airway was useful for airway managemant of Hutchinson-Gilford syndrome.
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Fade of the muscle contraction evoked by indirect tetanic nerve stimulation shows residual neuromuscular block. Anticholinesterases can reverse the partial block; however, they may also inhibit normal neuromuscular transmission and can cause fading responses by misuse of these drugs. The aim of this study is to investigate how neostigmine acts on normal neuromuscular function. ⋯ Therapeutic doses of neostigmine administered during normal neuromuscular function cause fade of the repetitive muscle contractions. Neuromuscular monitoring should be used before the reversal with neostigmine.
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A 76-year-old man underwent transurethral resection of bladder tumor under spinal anesthesia. Preoperative laboratory date showed normal platelet count (188,000 x microl(-1)) and normal coagulation profile (PT 11.4 sec, APTT 35.1 sec). Lumbar puncture was successfully performed at the L3-4 intervertebral space using a 27-gauge spinal needle with some technical difficulties. ⋯ On the 6th postoperative day, magnetic resonance image (MRI) showed a large epidural hematoma from L1 to L4. On the 13th postoperative day, the subjective symptoms disappeared and MRI on the 17th postoperative day revealed the absence of the hematoma. We should keep in mind that epidural hematoma as well as TNS can occur after spinal anesthesia even with a very fine needle.