Masui. The Japanese journal of anesthesiology
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Although most cesarean sections are done under spinal anesthesia, we often experience severe hypotension. Fluid resuscitation is usually carried out for prevention of hypotension, but it is difficult to assess the suitable infusion volume. We examined whether the urine specific gravity can predict hypotension after spinal anesthesia for cesarean section. ⋯ We concluded that it was difficult to predict hypotension by using urine specific gravity because the correlation was too weak.
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In tracheal intubation assisted by tube-guiding devices passing through the tube, such as fiberoptic scopes, bougies, tracheal tube exchange catheters, and light wands, passage of the tube-guiding device, by itself, is often easy. But advancing a tracheal tube with a conventional distal tip over these tube-guiding devices is frequently difficult or impossible, because its rigid, side-beveled tip frequently catches on anatomical features of the airway. ⋯ The gapless, midline travel of the Parker tube leads to a greater incidence of first-attempt intubation success with tube-guiding devices, because there is less risk of tube tip hang-ups on the arytenoids and the vocal cords. Clinically, use of the Parker tube is helpful for oral and nasal intubations, especially in patients with difficult airways.
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Randomized Controlled Trial
[Efficacy of bougie in difficult intubation with the Airway Scope caused by inability to lift the epiglottis directly].
There are some disadvantages of the Airway Scope (AWS), and the most crucial one is that the AWS has only one fixed-size AWS blade. When the blade is too short to reach beneath the epiglottis and to lift it directly, an endotracheal tube hits the epiglottis and cannot be advanced into the glottic aperture even when it is visible. A bougie may solve this difficulty because its angulated tip can be controlled in a desired direction. Therefore, we examined the efficacy of the bougie on this problem. ⋯ Use of the bougie was useful for difficult intubation with the AWS caused by inability to lift the epiglottis directly.
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An epidural catheter was inserted at the T10-11 interspace for the treatment of acute herpetic pain in a 68-year-old woman. Loss of resistance method with saline was used for identifying the epidural space. After negative aspiration test for cerebrospinal fluid and blood, continuous epidural infusion of 0.2% ropivacaine 2 ml x hr(-1) with intermittent injections of 1% mepivacaine 3 ml was performed for 20 days without side effects. ⋯ The symptoms and signs suggested subdural block. Migration of the epidural catheter into the subdural space may have occurred. Subdural block may occur even if the catheter is initially properly placed in the epidural space.
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A 22-year-old muscular karate player was diagnosed to have a tracheal tumor with a diameter of 2.8 cm that existed 2 cm under the glottis and occupied 60% of his trachea. He was scheduled for trachea resection and construction surgery. After awake-fiber intubation, anesthesia was maintained by continuous infusion of propofol and remifentanil, together with thoracic epidural anesthesia (T4-5). ⋯ It took almost 10 minutes to stop shivering completely, and the patient became too sedated and required noninvasive positive pressure ventilation overnight. We speculate that intraoperative remifentanil infusion induced severe shivering in this case. Shivering after remifentanil infusion can be a fatal complication in tracheal resection and construction surgery, especially in muscular patients.