Masui. The Japanese journal of anesthesiology
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Case Reports
[Compression of a nasotracheal tube in the nasal cavity of a patient with craniofacial fibrous dysplasia].
A 42-year-old woman with craniofacial fibrous dysplasia underwent osteoplasty of maxillary and mandibular bone. Preoperative CT images showed osteosclerosis and ground glass appearance of the right side of the skull including the orbit, temporal bone, paranasal sinus, and maxillary and mandibular bones, as well as hypertrophy of the nasal septum. ⋯ A part of the tube positioned in the nasal cavity was apparently compressed. Preoperative examination of the nasal cavity and nasal septum using CT or MRI may be desirable for nasotracheal intubation in the patients with craniofacial tumor, and the application of a spiral reinforced endotracheal tube may contribute to prevent such cases of airway obstruction in the nasal cavity.
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The fetoscopic laser coagulation of the vascular anastomoses on the monochorianic placenta for twin-to-twin transfusion syndrome (TTTS) has recently been shown to be effective. There have been few reports on the anesthetic techniques used for the fetoscopic laser coagulation. We report cases in which midazolam and fentanyl were used for the anesthetic management of the fetoscopic laser coagulation. ⋯ Continuous fentanyl infusion with midazolam provided acceptable maternal analgesia and sedation during endscopic treatment of TTTS. Careful titration with simulation of fentanyl concentration and respiratory monitoring enable safe and effective anesthesia management.
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The aim of this study was to assess how portable disposable patient-controlled epidural analgesia (PCEA) pumps (P group) affect the total costs of postoperative pain management compared with ordinary continuous epidural analgesia pumps without patient-controlled analgesia(C group). ⋯ PCEA pumps itself work out as designated insured medical materials and additional drugs for postoperative analgesia in the ward is cleared under the diagnosis procedure combination (DPC)-based payment system. Clearance of PCEA pumps under the DPC-based payment system and cost savings of additional drugs for postoperative analgesia in the ward contributed to increases in the profit of the hospital. The DPC-based payment system may offer an economic incentive to introduction of PCEA.
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In recent years, workload for a doctor has been increasing, because hospital managers are trying to improve the efficiency of management. As a result, many doctors are expected to work harder. We studied how anesthesiologists are stressed by their work, especially on working overnight, using the Profile of Mood States(POMS). ⋯ We studied anesthesiologist's stress of working overnight, using the Profile of Mood States. As a result, after overnight work, fatigue, confusion and vigor scores were significantly exacerbated. We speculate that the anesthesiologists are building up so much stress when they work overnight as on call.
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Brachial plexus injury has often occurred secondary to malposition of the patient during general anesthesia. We have experienced median nerve injury following laparoscopic sigmoidectomy. A 61-year-old man with diabetes and hypertension received laparoscopic sigmoidectomy under general and epidural anesthesia. ⋯ We suspect that his right median nerve injury was caused by compression and stretching of the brachial plexus in head down position, right lateral tilt table, use of shoulder brace, laparoscopy, abduction of the upper arm, and extension of the elbow. In laparoscopic operation in head down position, we should avoid using the shoulder brace to minimize the risk of brachial plexus injury. The arms should be approximated to the sides as nearly as possible and the elbows should be gently flexed to unload the median nerve and relieve tension on the brachial plexus.