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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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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Seven patients were subjected to intraoperative wake-up tests during reconstruction surgery of the anterior crucial ligament (ACL) to measure the tension of the reconstructed ligament. ⋯ Propofol-fentanyl is better than nitrous oxide-sevoflurane-fentanyl as the method of anesthesia for wake-up tests of ACL reconstruction surgery.
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Case Reports
[Laryngeal edema and vocal cord paralysis due to lithium battery ingestion; a case report].
We report a case of an 8-year-old boy with laryngeal edema and vocal cord paralysis due to lithium battery ingestion. He had ingested a lithium battery of a television remote controller, and was admitted to our hospital. He was suffering from wheezing and retractive respiration with crying. ⋯ He had no difficulty in breathing and eating but the vocal cord paralysis remained. Lithium batteries ingestion may cause severe airway injury in a short period because of their large size and high voltage. Immediate removal and careful management are required.