Masui. The Japanese journal of anesthesiology
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Five years have passed since out-of-hospital tracheal intubation training for advanced level ambulance crews (emergency life saving technicians: ELSTs) was started in Japan. Herein, we reviewed results of the initial training and reeducation program. ⋯ Sixty-three tracheal intubations were attempted between 2004 and 2009, of which 56 (89%) were successful and 7 (11%) unsuccessful, with ventilation maintained using another means such as a laryngeal mask airway or bag-valve-mask in the latter cases. Esophageal intubation occurred in 6 cases, but were immediately recognized and dealt with appropriately. Only 1 failed intubation patient, in whom esophageal intubation was changed to bag-valve-mask ventilation, survived until discharge. The average number of yearly intubation attempts (1.2) was small, thus nearly all ELSTs replied that they desired a reeducation program to maintain their intubation skills. Furthermore, some expressed a preference to receive reeducation under conditions close to actual emergency settings. That latter finding reflects the difficulty of out-of-hospital tracheal intubation performed in adverse conditions, such as in inappropriate patient or rescuer positions, and secretion or bleeding in the oral cavity.
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Case Reports
[Efficacy of continuous epidural saline infusion in cerebrospinal fluid hypovolemia: report of 5 cases].
We identified the sites of leakage by cisternography in 5 patients with cerebrospinal fluid hypovolemia and treated them by continuous epidural infusion with physiological saline solution. The results showed improvement in symptoms in all 5 patients, and lasting favorable results were obtained in 3 of them. ⋯ Adverse effects are the same as for ordinary epidural punctures. If the site of the cerebrospinal fluid leak has been specified and the treatment method is understood by the patient, we think that continuous epidural infusion with physiological saline is safe and effective method of treating cerebrospinal fluid hypovolemia.
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It is well known that buprenorphine compete with remifentanil for receptor binding. I have examined the effect of buprenorphine administration on postoperative analgesia following remifentanil-based anesthesia. ⋯ Buprenorphine is effective to some degree as a postoperative analgesic following remifentanil-based anesthesia, but is not sufficient in cases of severe postoperative pain.