Masui. The Japanese journal of anesthesiology
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In anesthetic induction of patients with severe aortic stenosis, maintenance of normal heart rate and blood pressure is critical. Remifentanil can blunt cardiovascular responses to tracheal intubation, but may cause circulatory collapse due to potent vasodilating effect. We studied retrospectively the optimal dose of remifentanil, which blunts cardiovascular responses to tracheal intubation and provides the hemodynamic stability to patients with severe aortic stenosis. ⋯ We found that more than 0.5 microg x kg(-1) x min(-1) of remifentanil can blunt cardiovascular responses to tracheal intubation without severe cardiovascular depression.
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Although the bispectral index (BIS) has been established as a common index of anesthetic depth, there is a possibility that head-up position may influence BIS values under general anesthesia. This study examined whether beach chair position with 57 degrees head-up would cause the variation of BIS values during shoulder surgery. ⋯ To our knowledge, this is the first report of the effect of beach chair position on BIS values intraoperatively. This result indicates that the beach chair position causes a time-dependent decrease in BIS under general anesthesia.
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We administered combined spinal anesthesia plus bilateral femoral nerve block in two cases undergoing bilateral simultaneous total knee arthroplasty. Although epidural catheters must be removed before anticoagulant treatment can be performed after surgery, femoral nerve block, poses minimal hindrance to anticoagulant therapy. Because femoral nerve block alone cannot provide sufficient postoperative pain relief after total knee arthroplasty, additional sciatic nerve block, spinal anesthesia, opioid administration, or some other means of analgesia is necessary. ⋯ However, intrathecal morphine can cause itching and late respiratory depression. Respiratory depression did not occur in either of the present patients, although case 2 experienced some itching. In conclusion, combined bilateral femoral nerve block with spinal anesthesia poses minimal hindrance to postoperative anticoagulation therapy and enables control of postoperative pain in patients undergoing bilateral simultaneous total knee arthroplasty.