Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study
[Technical advantages of ultrasound-guided obturator nerve block compared with the nerve stimulating technique].
We investigated the onset time of obturator nerve block and time required for the nerve block comparing two groups in a prospective randomized study. ⋯ Ultrasound imaging facilitated the identification of obturator nerves between adductor muscles. Ultrasound-guided obturator nerve block is a safe, quick and useful technique.
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Randomized Controlled Trial Comparative Study
[Effects of intravenous vasopressor on spread of spinal anesthesia with 0.5% hyperbaric bupivacaine for caesarean delivery].
It is known that when isobaric bupivacaine is applied for Caesarean delivery, phenylephrine is superior to ephedrine in preventing rostral spread of spinal anesthesia. In this study, we prospectively investigated whether phenylephrine can prevent rostral spread of spinal hyperbaric bupivacaine. ⋯ 1. Phenylephrine prevented rostral spread of spinal hyperbaric bupivacaine. 2. Haemodynamic changes were significantly different between the two groups. 3. Umbilical artery pH was significantly higher with phenylephrine than with ephedrine.
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We experienced two cases of anaphylaxis during anesthesia using rocuronium in two months. In both cases, we carried out intradermal test and positive reaction occurred with rocuronium. In both cases, the second anesthesia without neuromuscular blockade was uneventful. Though it is difficult to diagnose anaphylaxis, we should suspect anaphylaxis when cardiovascular collapse, bronchospasm and/or dermal symptoms occur after induction of anesthesia.
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A 31-year-old woman with aplastic anemia was admitted for the management of delivery at 33 weeks of gestation. Platelet count was 2.3 x 10(4) x microl(-1) on admission. Corticosteroid therapy after admission was not effective, and we decided to manage the delivery with elective cesarean section after platelet transfusion. ⋯ Blood loss during operation was 858 g, and complications were not seen during operation. In the case of delivery with uncontrolled aplastic anemia, elective cesarean section is thought to be safe. If platelet count is over 5.0 x 10(4) x microl(-1) after platelet transfusion, spinal anesthesia should be used.
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A 59-year-old woman with a body mass index of 30 and an edematous, tender goiter was scheduled for subtotal thyroidectomy. She had a history of dyspnea, cough, hoarseness, sleep disturbance in the supine position, difficulty in expelling sputum, and inability to rotate her neck to the left. Chest CT showed an adenomatous goiter, measuring 42 x 57 x 105 mm, with invasion into the mediastinal space, 17 mm right glottic shift, and 21 mm right tracheal shift. ⋯ Awake fiberoptic intubation was selected for anesthesia induction, and was easily performed using a Parker Flex-Tip tracheal tube (Parker Medical, Highland Ranch, Colorado, USA), after intravenous injection of 200 microg of fentanyl, 8% lidocaine pump spray on the larynx with a direct laryngoscope, and 5 ml of 4% lidocaine spray on the vocal cords and trachea through a bronchoscope. The operation was completed successfully without any adverse events. Awake fiberoptic intubation with a Parker Flex-Tip tracheal tube is easily performed in a patient with a difficult airway due to obesity, goiter, and laryngo-tracheal shift.