Masui. The Japanese journal of anesthesiology
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Twenty-two patients complicated with severe gestosis underwent cesarean section. General anesthesia was induced with intravenous thiopental and suxamethonium and maintained with sevoflurane below 1.5% with 40-50% oxygen and 50-60% nitrous oxide. Mean artery pressure at and after the induction as well as at the delivery, expired maternal sevoflurane concentrations at the delivery and neonate birth weight were measured for statistical analyses in relation with neonates pH of umbilical artery. Mean artery pressure at the delivery and neonates birth weight influence neonates pH of umbilical artery.
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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 measured the intracuff pressure of two different tracheal tubes, Portex Profile Soft-Seal Cuff with high N2O gas-barrier property and "high-volume, low-pressure" cuff (Mallincrodt Lo-Contour). Twenty adult patients undergoing elective abdominal surgery, were maintained with total intravenous anesthesia combined with epidural block, and ventilated with oxygen in air (FIO2 = 0.4). Initially, intracuff pressure was adjusted to 25 mmHg with air, and monitored over 180 min. ⋯ The decrease in intracuff pressure of Portex Profile Soft-Seal Cuff was significantly smaller than that of "high-volume, low-pressure" cuff 150-180 min later. We conclude that to prevent tracheobronchial aspiration during prolonged general anesthesia without N2O, tracheal tube cuff with gas-barrier property may be safer than usual "high-volume, low-pressure" cuff. We recommend to check the intracuff pressure especially during the first 30 min and at intervals of several hours.
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"Guidelines on Blood Products Use" published in 1999 recommends restricting the use of fresh frozen plasma (FFP) solely to correct multiple coagulation factor deficiencies. We retrospectively studied the use of FFP in patients with massive intraoperative bleeding before and after publication of the new guidelines. There were 22 patients whose blood loss was more than their circulating blood volume (7% of body weight) in the past two years. ⋯ FFP was given to all 22 patients. The mean dose of FFP decreased from 26.8 ml.kg-1 to 17.8 ml.kg-1 after publication of the new guidelines but the difference was not statistically significant. The volume infused was more than that recommended to improve blood coagulation in massive bleeding, i.e., 8-10 ml.kg-1.
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Case Reports
[Orotracheal intubation using a Styletscope in a patient with restricted opening of the mouth].
We used a Styletscope (FSS) for endotracheal intubation in a 61-year-old man with restricted mouth opening. The degree of mouth opening was only 1.5 cm. ⋯ After induction of anesthesia using propofol and vecuronium, orotracheal intubation was accomplished promptly and smoothly using this scope. The Styletscope is a useful device for orotracheal intubation in patients with restricted mouth opening.