Masui. The Japanese journal of anesthesiology
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Osteogenesis imperfecta (OI) is a rare hereditary disorder characterized by an excessive tendency to bone fractures and retarded growth, as well as variable involvement of other connective tissues such as teeth, sclerae, auditory bones and ligaments. A 30-year-old woman (body mass index of 39.6) with OI was scheduled for appendectomy. Because of obesity, abnormal cervical spine mobility and fragile teeth, in addition to the risk of mandibular and facial fractures, general anesthesia including airway management was considered to be difficult and, thus, avoided. ⋯ Although technical difficulty was expected with the blocks as well, epidural and spinal blocks were successfully performed using image intensifier. Neuraxial blocks for patients with skeletal abnormalities in the lumbar spine such as OI have been considered as relative contraindication. However, as described in this case report, these patients, in whom general anesthesia should be avoided, can benefit from neuraxial blocks with the help of image intensifier.
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In carotid endarterectomy (CEA), it is essential to maintain the systemic blood pressure (BP) and cerebral perfusion pressure, especially during cross clamping, and vasopressors are often required. To elucidate the effect of norepinephrine (NE) on the cerebral circulation in patients undergoing CEA, regional oxygen saturation (rSO2) in bilateral frontal poles was monitored by near infrared spectroscopy during NE infusion. ⋯ NE used to maintain the MAP decreased the brain rSO2. NE would aggravate the balance between cerebral oxygen supply and consumption in patients undergoing CEA. Further investigations are necessary to clarify the effect of systemically administered norepinephrine on the cerebral circulation.
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Case Reports
[Peripheral nerve blocks for amputation of lower limb in three critically ill patients].
In 3 critically ill patients, amputation of the lower limb above knee was performed uneventfully under femoral, sciatic, and obturator nerve blocks together with topical anesthesia of the lower limb.
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Fiberoptic bronchoscope (FOB)-guided intubation is an important and useful technique for unanticipated difficult airway in anesthetized patients. However, many staff anesthesiologists seemed to find it difficult to perform. We speculated that it was because they had not been well trained in the technique. We worked out an easy method for FOB-guided intubation. We had our residents try our method and measured the elapsed time in introducing FOB from the mouth to the tracheal carina. ⋯ We showed that our method helped anesthesiologists to master FOB-guided intubation.
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VATS (video-associated thoracic surgery) is mainly undertaken under general anesthesia only. Considering with patient's respiratory stability and postoperative pain relief, epidural anesthesia has advantages over general anesthesia. According to our clinical experience, side effects of epidural morphine, especially nausea and vomiting, often torture patients, especially woman. ⋯ Statistically significant gender differences of effectiveness and side effects of epidural morphine in VATS were observed only in nausea and vomiting.