Masui. The Japanese journal of anesthesiology
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Comparative Study
[Comparison of two methods of local anesthetic administration using three phantom tissue models].
Local anesthetic is often administered around surgical wounds to reduce pain. It remains unknown, however, how the agent diffuses into tissue, or whether the method of administration has any impact on the drug diffusion. We evaluated drug-diffusion areas around wounds after administering a dummy agent by needle injection (NI) and direct infiltration (DI) using three phantom tissue models : agar, sponge, and pork rib. ⋯ The direct infiltration method is likely to diffuse local anesthetic into tissue more uniformly and more extensively than the needle injection method.
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Case Reports
[Case of unexpected difficult intubation caused by asymptomatic congenital laryngeal web].
We report a case of unexpected difficult intubation in a patient with an asymptomatic congenital laryngeal web. A 44-year-old female with left ovarian tumor and endometrial polyp was scheduled for abdominal hysterectomy and left salpingo-oophorectomy under general anesthesia. ⋯ We finally could insert a tracheal tube of ID 6.5 mm into the dorsal side of the glottis. Airway Scope may be a useful device for unexpected difficult tracheal intubation.
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Randomized Controlled Trial
[Effect of pentazocine on the bispectral index during nitrous oxide-sevoflurane anesthesia].
The effect of pentazocine on the bispectral index (BIS) has not been reported. In this study, we have examined whether pentazocine alters the bispectral index during nitrous oxide-sevoflurane anesthesia. ⋯ We observed that intravenous pentazocine caused a significant increase in BIS under nitrous oxide-sevoflurane anesthesia. The depth of sedation should be assessed carefully using a bispectral index monitor when pentazocine is used together.
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Randomized Controlled Trial Comparative Study
[Influence of tidal volume on functional residual capacity during general anesthesia].
Ventilation with lower tidal volume improves outcome in acute respiratory distress syndrome (ARDS). However, it is questionable if ventilation strategy using lower tidal volumes created for patients with ARDS can be transferred to healthy patients undergoing general anesthesia. We assessed the effects of ventilation with lower tidal volumes and conventional tidal volumes on functional residual capacity (FRC) and Pa(O2)/FI(O2) (P/F) ratio in patients undergoing general anesthesia for upper abdominal surgery. ⋯ Lower tidal volumes are better than conventional tidal volumes in view of airway pressure and lung protective strategy during general anesthesia.
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Case Reports
[Case of large vein perforation caused by pumping using central venous catheter revealed by postoperative CT].
A 72-year-old woman, 157 cm in height and weighing 45 kg, was scheduled for emergency surgery for acute abdomen suggestive of gastrointestinal perforation. During the procedure, a triluminal central venous catheter (CVC) was inserted via the left internal jugular vein; venous blood could be aspirated separately through its lumens. On attempting blood transfusion, we noticed that the opening of one the CVC lumen tips was blocked and blood pumping was thus performed to achieve rapid transfusion. ⋯ After the intraoperative blood vessel perforation, the condition may have been aggravated by steroid use, amyloidosis, and blood vessel fragility, ultimately presenting the extravascular findings observed on CT. We thus believe that in cases where CVC is inserted via the left internal jugular vein, blood pumping in particular is believed to be dangerous. Although the risks of blood vessel perforation when using CVC are relatively low, the possibility of unexpected complications should be borne in mind.