Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
[Postoperative analgesia with morphine with or without diclofenac after shoulder surgery].
Balanced analgesia using a narcotic and a nonsteroidal anti-inflammatory drug has been successfully tested for postoperative analgesia. This study was designed to examine the efficacy of such combination therapy after shoulder surgeries. Twenty ASA physical status I or II patients, scheduled for shoulder surgeries under general anesthesia, were randomly assigned to either morphine (M) group (n = 10), who received IV morphine patient-controlled analgesia (PCA) alone (2 mg as a bolus, lock-out interval of 10-minutes, and 10 mg as 1-hour limit for 48 hours), or morphine + diclofenac (M + D) group (n = 10), who received, in addition to morphine PCA, diclofenac suppositories 50 mg.8 h-1 starting immediately before surgical incision for 48 hours. ⋯ No significant differences in VAS at rest and on movement were observed between the two groups. The time till the first bowel movement was significantly shorter in the M + D group. Our data suggest that diclofenac suppositories 50 mg.8 h-1 starting immediately before surgery for 48 h are effective adjuvant in reducing post-shoulder surgery morphine requirement and retardation of bowel movement.
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Case Reports
[A case report of hemidiaphragmatic paresis caused by interscalene brachial plexus block].
A 76-yr-old woman was scheduled for left upper extremity orthopedic procedure. Preoperative examinations were within normal limits except forced vital capacity. Interscalene brachial plexus block with 0.25% bupivacaine 15 ml, was performed under general anesthesia. ⋯ A chest X-ray demonstrated the elevation of hemidiaphragm. She was diagnosed as ipsilateral hemidiaphragmatic paresis, treated with oxygen inhalation under deep breathing for approximately one hour, and then transferred to the common ward. We conclude that respiratory movement should be carefully observed following interscalene brachial plexus block especially in geriatric patients.
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Case Reports
[Anesthetic management of a neonate with laryngotracheoesophageal cleft and tracheoesophageal fistula].
Laryngotracheoesophageal cleft (LTEC) is an extremely rare congenital anomaly characterized by an absence of all or a part of the tracheoesophageal septum producing an abnormal communication between the trachea and esophagus, and is often difficult to be diagnosed. A 2-day-old male baby was tentatively diagnosed as tracheoesophageal fistula type Gross C, and underwent gastrostomy. The trachea was intubated before anesthetic induction. ⋯ Endoscopic examination performed 2 weeks later gave diagnosis of LTEC type 3. It is likely that the endotracheal tube might have been advanced into the end of the esophagus due to absence of the tracheoesophageal septum. In spite of a rare disease, LTEC should be considered as an extreme case of transesophageal fistula with a high risk of difficult airway.
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Epidural anesthesia in pediatric patients has become popular, and some useful techniques have been introduced. We use the pressure-guided method to identify the epidural space. This method enables us to visualize, on the monitor, the pressure change as the needle advances. ⋯ In the first 10 months after I started working as a resident in anesthesia, I performed 16 pediatric epidural anesthesias successfully under the direction of the anesthetic specialist. I would like to emphasize that I was able to perform epidural anesthesia safely at the thoracic level (T 11 x 12) even in the newborn (body weight 3400 g). The pressure-guided method enables us, even a new resident, to accomplish epidural anesthesia at thoracic level in newborn.
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We report a case of malignant goiter with severe tracheal stenosis. The patient was a 61-year-old female, who had orthopnea on admission. Radiological examinations revealed a tracheal stenosis extending from 4.5 cm to 8 cm below the glottis; the smallest caliber being 5 mm. ⋯ Unexpectedly, the tube could be advanced through the stenosis without resistance. After induction of general anesthesia, the patient was placed in a supine position, and a tracheotomy was performed. This case demonstrates that, while intubation of the trachea through a stenosis is sometimes dangerous, it may be indicated when the inner surface of the trachea is intact and a tube with an inner diameter greater than 5 mm can then be placed.