Masui. The Japanese journal of anesthesiology
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A 34-year-old woman who was 25 weeks pregnant showed neurological symptoms of bitemporal hemianopsia and vision loss on the left side. MRI study revealed a pituitary tumor requiring surgical removal. We planned cesarean section after 32 weeks of pregnancy and removal of pituitary tumor after the improvement of general conditions of the paturient following cersarean section. ⋯ Therefore, we decided to perform the cesarean section at 30 weeks and 3 days of pregnancy and simultaneous surgical removal of the pituitary tumor. As soon as cesarean section was successfully performed with epidural anesthesia, the pituitary tumor was removed trans-sphenoidally under general anesthesia. Postoperative conditions of the mother and newborn were good and neurological symptoms of the mother improved markedly.
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Randomized Controlled Trial Comparative Study
[Technical advantages of ultrasound-guided obturator nerve block compared with the nerve stimulating technique].
We investigated the onset time of obturator nerve block and time required for the nerve block comparing two groups in a prospective randomized study. ⋯ Ultrasound imaging facilitated the identification of obturator nerves between adductor muscles. Ultrasound-guided obturator nerve block is a safe, quick and useful technique.
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Randomized Controlled Trial Comparative Study
[Effects of intravenous vasopressor on spread of spinal anesthesia with 0.5% hyperbaric bupivacaine for caesarean delivery].
It is known that when isobaric bupivacaine is applied for Caesarean delivery, phenylephrine is superior to ephedrine in preventing rostral spread of spinal anesthesia. In this study, we prospectively investigated whether phenylephrine can prevent rostral spread of spinal hyperbaric bupivacaine. ⋯ 1. Phenylephrine prevented rostral spread of spinal hyperbaric bupivacaine. 2. Haemodynamic changes were significantly different between the two groups. 3. Umbilical artery pH was significantly higher with phenylephrine than with ephedrine.
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We experienced two cases of anaphylaxis during anesthesia using rocuronium in two months. In both cases, we carried out intradermal test and positive reaction occurred with rocuronium. In both cases, the second anesthesia without neuromuscular blockade was uneventful. Though it is difficult to diagnose anaphylaxis, we should suspect anaphylaxis when cardiovascular collapse, bronchospasm and/or dermal symptoms occur after induction of anesthesia.
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A 31-year-old woman with aplastic anemia was admitted for the management of delivery at 33 weeks of gestation. Platelet count was 2.3 x 10(4) x microl(-1) on admission. Corticosteroid therapy after admission was not effective, and we decided to manage the delivery with elective cesarean section after platelet transfusion. ⋯ Blood loss during operation was 858 g, and complications were not seen during operation. In the case of delivery with uncontrolled aplastic anemia, elective cesarean section is thought to be safe. If platelet count is over 5.0 x 10(4) x microl(-1) after platelet transfusion, spinal anesthesia should be used.