Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Effects of anesthetic agents on seizure duration and hemodynamics in electroconvulsive therapy].
Thiopental and suxamethonium have been recommended as anesthetic agents for electroconvulsive therapy (ECT). We hypothesize that propofol and vecuronium can also be used and superior to thiopental and suxamethonium in seizure duration and hemodynamics. ⋯ Rocuronium, which will be used for ECT in future, is needed to be studied in suxamethonium-controlled design.
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Case Reports
[Pain management using patient controlled epidural analgesia for transient osteoporosis of the hip in pregnancy].
We report the case of a 37-year-old woman who developed severe pain in bilateral legs and hip in the eighth month of pregnancy. She was diagnosed as transient osteoporosis of the hip in pregnancy by the MRI findings. ⋯ After delivery, diclofenac sodium was administered for three weeks. Complete clinical improvement was observed in the seventh month after delivery.
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A 68-year-old man was scheduled for pancreaticoduodenectomy under general anesthesia. He was suffering from Charcot-Marie-Tooth disease (CMTD) for 34 years, and complicated with liver cirrhosis. Anesthesia was induced with propofol and fentanyl, and maintained with oxygen-air-sevoflurane and remifentanil. ⋯ Rocuronium was injected intravenously for tracheal intubation, supplemented as required using an electrical nerve stimulator. The longer duration of action of rocuronium was observed in this case because the patient was complicated with CMTD and liver cirrhosis. We suggest that monitoring neuromuscular function may be necessary to detect subtle residual neuromuscular blockade when rocuronium is used in a patient with CMTD and liver dysfunction.
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Case Reports
[Perioperative management of a patient with Parkinson's disease with intravenous infusion of levodopa].
Parkinson's disease is a disorder of the extrapyramidal system resulting from the deficiency of dopamine in the basal ganglia. We experienced the perioperative management of a patient with Parkinson's disease with intravenous infusion of levodopa, precursor of which is dopamine. A 73-year-old woman with Parkinson's tremor in her bilateral fingers of Hoehn and Yahr stage II was scheduled for repair of bladder prolapse under general anesthesia. ⋯ Levodopa/carbidopa 400 mg per day had been administered orally after the first operative day. She did not show deterioration of her symptom of Parkinson's disease, and develop any complications during the perioperative period. We need to manage Parkinson's disease with intravenous infusion of levodopa during the perioperative period, taking care of the symptom of Parkinson's disease and the occurrence of complications.
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In adult patients, there is a strong correlation between the appropriate depth of insertion of a left double-lumen endobronchial tube (DLT) and height. However, for patients with the same height, we noted the tendency of the depth of insertion being about 1 cm shorter for patients under 19 years of age compared to that for those over 20 years. ⋯ During intubation of the bronchi with DLT in patients under 19 years, the optimal depth of DLT insertion is less than that for patients over 20 years.