Masui. The Japanese journal of anesthesiology
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Epidural anesthesia is widely used in patients who undergo thoracic, abdominal or lower extremity surgeries and generally considered useful for perioperative analgesic management. Epidural catheterization is often associated with some complications including misplacement of the catheter. Epidural catheters are known to be misplaced or migrate into subarachnoidal space, subdural space, vessels and thoracic cavities ; however, frequency, predominant sites of misplacement, and the timing of detection are not fully understood regarding the misplacement of the catheters. ⋯ Epidural catheters were misplaced to subarachnoid space in 6 cases and thoracic cavity in 2 cases. The misplacement of the catheters was found before the induction of general anesthesia in 2 patients, after induction of general anesthesia in 1 patient, during surgical procedure in 3 patients, and postoperatively in 2 patients. Since misplacement of epidural catheters can occur at any moment during perioperative period, continuous monitoring and observation of patients seem to be very important to prevent and minimize the adverse events related to the misplacement of epidural catheters.
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Comparative Study
[Comparison of levobupivacaine and ropivacaine for postoperative epidural analgesia].
Levobupivacaine is a long acting local anesthetic with less cardiovascular toxicity. Recently we can use levobupivacaine for postoperative analgesia. We retrospectively compared levobupivacaine with ropivacaine for the postoperative epidural analgesia in patients undergoing gynecological abdominal surgery. ⋯ These results suggest that the use of epidural 0.24% levobupivacaine in the patients undergoing the gynecological surgery is superior to the use of 0.19% ropivacaine.
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Swyer-James syndrome (SJS) shows the constellation of radiographic findings of a small, hyper lucent lung, with an ipsilateral, diminished peripheral vasculature, air trapping, and a lack of peripheral fill on bronchography. We report a case of 70-year-old woman with SJS who underwent pulmonary resection of the normal side lung for lung tumor. Because of this syndrome, we could predict the hypoxia during one-lung ventilation. ⋯ As we could not improve the hypoxia in spite of increasing FI(O2), O2 administration to the operating side lung was started. Sp(O2) recovered after O2 administration. For anesthetic management of a patient with SJS in the normal-side-lung, it is essential to prevent the hypoxia during one-lung ventilation.
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A 60-year-old morbidly obese woman (150 cm, 112 kg, BMI 49.8) underwent total knee replacement under general anesthesia combined with sciatic nerve block and continuous femoral nerve block. Following induction of general anesthesia and tracheal intubation, the sciatic nerve was blocked using the popliteal approach with the patient in the supine position. Then the femoral nerve block was performed, followed by perineural catheter placement for postoperative continuous local anesthetic infusion. ⋯ Postoperatively 0.15% ropivacaine was infused at the rate of 5 ml x hr(-1) for 60 hours through the femoral catheter, which provided satisfactory pain relief in combination with scheduled loxoprofen administration. No block-related complications were noted. Our experience suggests that the ultrasound-guided technique may prove useful to facilitate safe and accurate block when technical difficulties are anticipated with anatomic landmark-based approaches.
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Comparative Study
[Comparison of thoracoscopic and open repair of esophageal atresia with tracheoesophageal fistula].
With the increasing use of endoscopic surgery in children, several papers report the comparison between the thoracoscopic and open repair of the neonatal esophageal atresia with tracheoesophageal fistula (EA/TEF). Most of them focus on the duration and outcome of the surgery with few focusing on the neonatal tolerance to the thoracoscopic procedure and intraoperative anesthetic management. ⋯ Hypercapnia and acidosis were severer in thoracoscopy group. Careful perioperative adjustment of inspired oxygen fraction and ventilator setting is required.