Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Effects of concentration and dosage of lidocaine on preventing the pain on injection of propofol].
Although it is well-known that 2% lidocaine has an effective action for preventing propofol-induced pain, it has been unclear whether or not lidocaine of the concentration below 2% has the effective action similar to 2% lidocaine. One-hundred and thirty-two patients were randomly assigned to one of the six groups according to concentration and dosage of lidocaine administered at the time of the initiation of propofol infusion. Groups I and II received 1 ml and 2 ml of 1% lidocaine, respectively; Groups III and IV were given 1 ml and 2 ml of 0.5% lidocaine, respectively; Group V received 2 ml of 2% lidocaine; Group VI was administered 1 ml of normal saline as a control. ⋯ Number of patients complaining of a pain during induction was more in Group VI with significance (P < 0.0001) and number of patients complaining of uncomfortableness was also more with significance (P < 0.0001). Incidence of propofol-induced pain and degree of satisfaction with anesthetic induction were similar among the groups receiving lidocaine. Even 0.5% lidocaine may have the same effective action as 2% lidocaine for preventing the pain on injection of propofol.
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We report a case of myoglobinemia observed in the postoperative period due to forced positioning during nephrectomy. A 32-year-old male, weighing 93 kg, underwent the left nephrectomy due to renal cell carcinoma under general anesthesia with epidural block. The operation was performed uneventfully but he complained of severe pain in his right hip immediately after the recovery from anesthesia. ⋯ CT findings showed topical edema or necrosis of his right minor and medial gluteus muscle. Myoglobinemia continued only for 3 days after the operation without renal dysfunction. We may conclude that muscle injury during an operation followed by forced positioning for nephrectomy is caused not only by direct compression of the muscle, but also by obstruction of the profound intramuscular artery.
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Clinical characteristics of perioperative pulmonary thromboembolism (PTE) at Kitasato University Hospital in Japan were analyzed. Eighteen patients were documented as apparent diagnosis of PTE which developed perioperatively in the period of 1991-1999. The incidence of PTE was 18 out of approximately 50,000 surgical cases. ⋯ Perioperative PTE tended to occur in patients with laparoscopic cholecystectomy (3/18) and cesarean section (3/18). Seven out of 18 PTE patients died. It should be noted that perioperative PTE is prevalent in patients with risk factors of obesity and prolonged bed rest after surgery, and that laparoscopic cholecystectomy and cesarean section may become additional risk factors in patients who are otherwise healthy young adults.
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A 76-yr-old male presented for leg amputation above the knee. The patient complained of dyspnea due to pulmonary embolism occurring 3 weeks before operation. ⋯ The nerves were anesthetized with 0.75% ropivacaine solution 31 ml by use of an electrical nerve stimulator and an insulated needle. Nerve stimulation technique is the best choice for patients who are unable to report paresthesias reliably.
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We reported five patients had developed sudden bradycardia and hypotension under spinal anesthesia during transurethral resection of the prostate. The symptoms occurred not only just after the induction of spinal anesthesia, but also at the end of operation. It seems that these symptoms are caused from water intoxication, myocardial ischemia or vagal reflex. This emphasizes the importance of rigorous vigilance on patients until the end of operation.