Masui. The Japanese journal of anesthesiology
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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.
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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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Randomized Controlled Trial Comparative Study
[Comparison of usefulness of the dorsal branch of the radial artery with the radial artery for arterial cannulation].
The radial artery cannulation is often associated with damped arterial waveforms with the hand moving. We used cannulation of the dorsal branch of the radial artery (DRA) and compared the stability of measurement, safety and complications with those of the radial artery(RA). ⋯ Arterial line monitoring from DRA had better waveforms compared with RA monitoring without any complications.
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Randomized Controlled Trial Comparative Study
[Anesthesia for electroconvulsive therapy -- comparison of propofol with sevoflurane].
Electroconvulsive therapy (ECT) is performed under general anesthesia (GA). GA could reduce the vigorous hemodynamic response including hypertension and tachycardia during ECT. This may be beneficial in patients with cardiovascular diseases. On the other hand, however, many intravenous and inhalational anesthetic agents potentially suppress the seizure and shorten the duration. The aim of this study is to elucidate whether propofol is superior to sevoflurane in maintaining the duration of electroencephalographic (EEG) seizure evoked by Thymatron System while stabilizing hemodynamic responses. ⋯ The duration of EEG seizure in ECT was significantly longer with propofol anesthesia than sevoflurane anesthesia. Propofol may provide more benefits than sevoflurane as the anesthetic for ECT.
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A 17-year-old man was scheduled for ventriculo-peritoneal shunt under general anesthesia. Anesthesia was induced by propofol, rocuronium and pentazocine, and maintained with sevoflurane and nitrous oxide. The operation was finished in 1 hour and 4 minutes without trouble. ⋯ He showed no troubles thereafter, and left hospital. After introduction of sugammadex to clinical use, 7 cases of anaphylactic reaction to sugammadex were reported. We must know that anaphylactic reaction can be induced by sugammadex.