Masui. The Japanese journal of anesthesiology
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In Japan, about 40% of all the parturients give birth in small obstetrician's clinics. There is no anesthesiologist in most clinics. The labor analgesia is not performed or is performed by the obstetrician in many facilities. ⋯ Adequate pain relief and high satisfaction were ascertained by the questionnaire to the parturients who had received labor analgesia in this hospital. The number of parturients who request labor analgesia is increasing. However, it is difficult or almost impossible to provide labor analgesia by one anesthetist for 24 hours and 365 days.
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Labor epidural analgesia is unfamiliar to parturients in Wakayama Prefecture partly because of insufficient information and medical services for expectant mothers given by anesthesiologists and other medical staffs. We offered introductory approaches for providing epidural analgesia for labor and delivery in our obstetric care unit. ⋯ We spent considerable time to achieve better communication with midwives and obstetricians in order to improve our professional qualities for caring labor pain. After practical approach of labor epidural analgesia, midwives came to accept epidural analgesia as an option during childbirth.
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Case Reports
[Unsuccessful anesthetic management for cesarean section in a patient with primary pulmonary hypertension].
A 31-year-old woman with primary pulmonary hypertension presented for an elective cesarean section at the 34-week gestation. After monitoring pulmonary artery, systemic artery blood pressures and an electrocardiogram, continuous lumbar epidural anesthesia was performed. Uneventful delivery was followed by a sudden decrease in systemic pressure and loss of consciousness. ⋯ Nitroprusside and milrinone were infused to decrease pulmonary artery pressure and to maintain systemic arterial pressure. However, she died after 16 hours due to an impairment of right ventricular function. Although the patient with PPH had been managed successfully using continuous epidural analgesia until delivery, sudden hemodynamic alterations following delivery could not be controlled by pharmacological interventions.
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A 38-year-old woman with placenta previa was scheduled for cesarean section. She had no abnormal medical history including neurological deficit before the operation. Prior to general anesthesia, an epidural catheter was inserted in the L2-3 interspace for postoperative analgesia. ⋯ MRI and myelogram showed no abnormality of the spinal cord. Her neurological deficit showed slight improvement but her sensory and motor paralysis still remained. Neurotoxicity of ropivacaine may be the cause of this neurological deficit.
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Comparative Study
[Experience in postoperative sedation with dexmedetomidine for mandibular osteotomy].
Dexmedetomidine may be suitable for postoperative sedation of patients with mandibular osteotomy. ⋯ This study shows that sedation with dexmedetomidine is more suitable than that with midazolam.