Masui. The Japanese journal of anesthesiology
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Successful airway management in an adult female patient with limited cervical extension and a subluxation of bilateral jaw joints caused by rheumatoid arthritis was reported. We planned to reduce the intensity of pain in her right hand through neurolysis of the ulnar nerve in her right elbow joint. Right axillary nerve blockade with 1% lidocaine 10 ml and 0.25% bupivacaine 10 ml, was employed unsuccessfully to achieve adequate anesthetic effect. ⋯ Anesthesia was maintained with sevoflurane 1.5-2.0% in oxygen under spontaneous breathing. Emergence from anesthesia was rapid and no signs of upper airway obstruction were observed after the removal of the LMA. The use of the LMA with VCRII technique and anesthetic maintenance using sevoflurane, are likely to be an optional technique of airway management in patients with problematic airway.
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We report here an efficient means of epidural catheter placement through atlanto-occipital membrane in rats. ⋯ Although this approach for epidural catheter placement is efficient and produces excellent drug effects on day 3 after implantation, as reported by others, rapid development of fibrous tissue around the catheter quickly limits the usefulness of the epidural catheter.
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A 38-year-old female, at 38-week gestation, was scheduled for cesarean section under epidural anesthesia. After the delivery, it was found that she had been diagnosed as myotonic dystrophy by the other physician and the neonate was a floppy infant indicating hereditary neuromuscular diseases. ⋯ We previously had given her general anesthesia for two times with nitrous oxide, isoflurane and vecuronium for her to undergo emergency operations, left salpingectomy under laparoscopy due to unruptured tubal pregnancy at 34 years of age and cesarean section due to liver function disorder indicating HELLP syndrome at 36 years of age. Although many problems have been described about the perioperative management in patients with myotonic dystrophy, she was safely managed for each operation.
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To make the public aware of the risks of anesthesia, we prepared an explanatory note composed of 634 Japanese characters or of 248 English words. The incidences of fatal anesthetic complications over a five-year period in 2,358,642 anesthetics in 741 Certified Training Hospital belonging to the Japanese Society of Anesthesiologists were cited in the explanatory note. Patients were asked to read and sign the explanatory note prior to agreeing to surgery. ⋯ Thereafter, responsible anesthesiologists visit and evaluate patients, and explain common as well as specific anesthesia risks to each patient. A survey by mailing questionnaires regarding this explanatory note and anesthesia risks sent to patients, who had read and signed the explanatory note, revealed that the patients were generally satisfied with the content of the explanatory note. This system may help patients, surgeons and anesthesiologists to recognize anesthesia risks on the same basis.
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The anesthetic management of a patient with xeroderma pigmentosum is described. A 17-year-old woman underwent tracheostomy because of progressive recurrent nerve palsy. The operation was performed uneventfully under general anesthesia using propofol and fentanyl. ⋯ Classical types of XP have a defect in nucleotide excision repair (NER). It has been reported that volatile anesthetics such as halothane deranged NER in cells obtained from an XP patient. Thus, general anesthesia using volatile agents should be avoided, if possible, because inhalation anesthetics may worsen the symptoms of XP.