Masui. The Japanese journal of anesthesiology
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We managed 10 cases of propofol anesthesia with rocuronium, and recorded the time course of the neuromuscular blockade evaluated through accelerometry, as well as the estimated blood concentrations of rocuronium calculated from the administration history with a pharmacokinetic simulation analysis. Rocuronium was injected at 0.6 mg x kg(-1) initially, and the infusion rates were managed in order to maintain a twitch height at 3-10% of the control. ⋯ The time to spontaneous recovery with a twitch height of 25% and a reappearance of the fourth response in train-of-four ratio (TOF ratio) nerve stimulation was twenty minutes, even after a five-hour infusion, and was not affected by the length of the infusion. Thus, continuous infusion of rocuronium might be an effective and safe way to maintain appropriate neuromuscular blockade.
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A 53-year-old woman who had experienced symptoms of fulminant malignant hyperthermia (MH) by sevoflurane a week before and her MH muscle biopsy revealing positive later, underwent the right hemicolectomy under total intravenous anesthesia with propofol and fentanyl. The patient's body temperature increased at a rate of 0.6 degree C per 15 min from 37.5 to 39.4 degrees C, but other symptoms of MH, such as tachycardia, arrhythmia, acidemia, and hypoxemia, were obviously slight in comparison with those induced by sevoflurane. ⋯ However, it decreased to 37.8 degrees C after discontinuation of propofol and dantrorene injection again. It is well recognized that propofol is not a MH trigger, but it shoud be noted that some MH patients could experience a hypermetabolic state, such as hyperthermia, even by propofol.
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In Japan, endovascular abdominal aneurysm repair became one of the standard procedures in 2006. It has been performed in 8 patients at our hospital. ⋯ We usually use radiographic monitoring for safe and precise insertion of the catheter into the epidural space. Epidural catheterization with radiographic monitoring is useful for safe and reliable epidural analgesia.
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As laparoscopic cholecystectomy is assumed to be with less postoperative pain, it is managed only by general anesthesia during the surgery in our hospital. However, about 70 percent of cases needed the additional analgesic drugs after the operation. In addition, about 70 percent needed analgesic drugs within three hours after the operation, and it has been understood that early postoperative analgesia is insufficient. We focused on the ultrasound guided nerve block and used it to relieve postoperative pain after the laparoscopic cholecystectomy. ⋯ The use of ultrasound guided nervous block for the postoperative pain after laparoscopic cholecystectomy has been helpful, and excellent pain relief has been obtained.
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Comparative Study
[Postoperative nausea, vomiting and pain after pediatric outpatient surgery : comparison of laparoscopic and conventional inguinal hernia repair].
The number of laparoscopic surgery is increasing in pediatric surgery. There are few studies in which the pediatric outpatient postoperative course was compared between the laparoscopic and conventional open surgery. ⋯ The patients undergoing LPEC required more postoperative analgesics. The measures to lower postoperative nausea and vomiting should be adopted in these patients.