Masui. The Japanese journal of anesthesiology
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Case Reports
[Unintentional total spinal anesthesia during cervical epidural block with ropivacaine].
We present a case of unintentional total spinal anesthesia, which occurred during cervical epidural block. A 34-year-old man with complex regional pain syndrome of the right upper arm was treated with epidural block at C7-T1 interspace. Immediately after test-dose injection of ropivacaine 1.5 ml, he complained of paresthesia of his upper extremities. ⋯ Neurological dysfunction was not seen thereafter. Although test-dose injection is recommended especially in high-risk patients and case of difficulty of epidural space identification, it does not fully prevent complications. For cervical epidural block, local anesthetics should either be given at small doses or not be given as long as a possibility of spinal injection is remaining.
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Clinical Trial
[Clinical experience of tracheal intubation using Trachlight in patients with unstable dentition].
Trachlight is a light-tipped stylet designed to guide tracheal intubation. It obviates the need for direct laryngoscopy and is reported to be particularly useful for managing difficult tracheal intubation. Its clinical application, however, is not limited to difficult airway management. ⋯ Our experience suggests that Trachlight can be a helpful tool for intubation in patients having dental problems. Because of the blind nature of the technique, but preexisting lesions of the larynx and vocal cords might be overlooked in intubation using Trachlight. Further investigation is warranted to recommend Trachlight as a intubation technique of choice in patients with unstable dentition.
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We report a patient who developed pulmonary edema due to airway obstruction after extubation. A 22-year-old man underwent removal of the nails for thoracoplasty under general anesthesia combined with epidural anesthesia. Upper airway obstruction occurred after extubation. ⋯ However, inspiratory wheezing was heard over both lung fields. Chest X-ray taken 90 minutes after the event revealed pulmonary edema. Pulmonary edema gradually resolved after intravenous furosemide and oxygen inhalation by mask.
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Comparative Study
[Comparison of pentazocine and fentanyl in total intravenous anesthesia using propofol].
Pentazocine may be an alternative for fentanyl during total intravenous anesthesia (TIVA) using propofol. The authors compared the efficacy and safety of pentazocine for analgesics in TIVA using propofol. ⋯ The results suggest that pentazocine would provide a stable hemodynamic state, rapid recovery and an effective postoperative pain relief to the same degree as with fentanyl in TIVA with propofol.
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Case Reports
[Pharmacokinetic simulation of high-dose administration of dexmedetomidine for decubitus treatment].
We used only dexmedetomidine to sedate a patient with Alzheimer disease, Parkinson's syndrome and emaciation for decubitus treatment in the prone position. The infusion rate of dexmedetomidine without a loading dose was increased until sufficient sedation was attained. The maximum plasma concentration and the plasma concentration in a stable state, which were calculated by pharmacokinetic simulation analysis, were 2.3 ng x ml(-1) and 1.5 ng x ml(-1), respectively. ⋯ It was found by pharmacokinetic simulation analysis that the plasma concentration of dexmedetomidine required for decubitus treatment might be higher than the plasma concentration considered to be necessary for sedation in intensive care units. The simulation was conducted to administer dexmedetomidine, to estimate hemodynamic reaction, and to estimate the necessary plasma concentration. We conclude that dexmedetomidine is useful as an anesthetic agent for decubitus treatment in the prone position, although further investigations with regard to its safety are required.