Masui. The Japanese journal of anesthesiology
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Recently, rocuronium is being used in patients for caesarean section undergoing general anesthesia instead of suxamethonium. An increased dose of rocuronium improves intubating conditions but prolongs neuromuscular blockade. Sugammadex reverses rapidly and predictably even profound rocuronium-induced neuromuscular blockade. ⋯ However, in one patient who had chronic renal failure (creatinine clearance rate: 12 ml x min(-1)), 10 minutes were required for TOF to recover to more than 0.7, and TOF never reached 0.9. All patients were successfully intubated at the first attempt. No signs of recurarization or adverse effects related to sugammadex were noted in the perioperative period.
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Randomized Controlled Trial Comparative Study
[Long-term effects of pulsed radiofrequency on the dorsal root ganglion and segmental nerve roots for lumbosacral radicular pain: a prospective controlled randomized trial with nerve root block].
Although pulsed radiofrequency (PRF) method for lumbosacral radicular pain (LSRP) is reportedly effective, there are no prospective controlled trials. We assessed the long-term efficacy of PRF of the dorsal root ganglion and nerve roots for LSRP as compared with nerve root block (RB). ⋯ This study indicates that PRF adjacent to the dorsal root ganglion and nerve roots for LSRP has long-term effects. There were no significant differences of long-term effects between the two groups.
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Neuromuscular blocking drugs (NMBDs) can predispose patients with myasthenia gravis to postoperative paralysis and respiratory complications. We had a 12-year-old female patient undergoing thoracoscopic thymectomy. She had suffered from MGFA class IIa (mild systemic) myasthenia gravis for 4 months. ⋯ Intercostal nerve block with 0.2% ropivacaine was performed to relieve postoperative pain. TOF ratio was 32% at the end, when we gave 2 mg x kg(-1) of sugammadex to get 100% reversal of neuromuscular blockade in 120 seconds. There was no residual paralysis and respiratory complications postoperatively.
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Comparative Study
[Effect on fetal umbilical arterial blood of administration of vasopressors for hypotension after spinal anesthesia during cesarean section].
Spinal anesthesia was performed in 40 patients undergoing cesarean section. When systolic blood pressure dropped below 100 mmHg, phenylephrine 100-200 microg (P group) or ephedrine 5-10 mg (E group) was administered. The pH of the umbilical arterial blood was collected after delivery of the baby. ⋯ Recently, it is reported that the umbilical arterial pH is higher in cases in which phenylephrine is used for hypotension after spinal anesthesia during a cesarean section. However, the optimal dose of phenylephrine is debatable and has not been established. More studies are necessary to determine which drugs should be selected according to the maternal condition.
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A 68-year-old male patient underwent laparoscopic cholecystectomy under general anesthesia. Following anesthesia induction and muscle relaxation, laryngoscopy using Macintosh laryngoscope found a tumor of thumb size above the glottis completely obscuring the vocal cords. There appeared to be a possibility of tumor impaction into the glottis leading to total obstruction when the tumor was pushed down by a tracheal tube. ⋯ N. T. surgeon found no evidence of scarring or healing in the throat. The cyst might have been ruptured at the time of extubation or afterward, or absorbed.