Masui. The Japanese journal of anesthesiology
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We describe a case of Freeman-Sheldon syndrome that presented some problems for anesthetic management. A 2-yr-old girl required orthopedic surgery for the bilateral lower extremities. Anesthesia was induced via a mask with oxygen (2 l.min-1), nitrous oxide (4 l.min-1) and sevoflurane (approximately 5%). ⋯ Combined caudal epidural block was, however, avoided because spina bifida occulta was suspected. Spina bifida occulta was revealed postoperatively by X-ray. For anesthetic management of a patient with Freeman-Sheldon syndrome, the spine should be evaluated preoperatively when performing epidural/spinal anesthesia.
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The effects of vasodilators and anesthetics on the circulatory and metabolic conditions were compared during hypotensive anesthesia. Forty two subjects undergoing tympanoplasty were divided into 6 groups: PG + S: N2O/sevoflurane with prostaglandinE1 (PG), TM + S: N2O/sevoflurane with trimetaphan (TM), NG + S: N2O/sevoflurane with trinitoglycerin (NG), PG + P: N2O/propofol with PGE1, TM + P: N2O/propofol with TM, NG + P: N2O/propofol with NG. ⋯ Although pHi decreased slightly during hypotensive anesthesia in all groups, pHi was not decreased below the critical level of 7.30. The circulatory and metabolic conditions under induced hypotensive anesthesia were influenced by both vasodilators and anesthetics, and the dosage of vasodilator to decrease arterial blood pressure was dependent on the anesthetic used simultaneously.
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Effects of autologous blood transfusion and isovolemic colloids transfusion on hemorrhagic shock model in rats were investigated. The hemorrhagic shock model in rats was prepared by rapid exsanguination and the blood pressure was kept at 40 mmHg for 30 min. As a marker of hemodynamic change, the blood gas analysis was performed, and the tissue oxygen pressure of the liver and the spleen was also measured. ⋯ However, the liver PtO2 did not show any changes during hemorrhagic shock, although the spleen PtO2 tended to decrease. These changes seen at the hemorrhagic shock were equally restored after the treatment with either autologous blood transfusion or isovolemic colloids transfusion. These results indicate that either autologous blood transfusion or isovolemic colloids transfusion can be useful for the therapy of severe hemorrhagic shock, and the NO production in the liver can participate in the maintenance of homeostasis under hemorrhagic shock.
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We found fine cracks in a three-way stopcock after continuous infusion of propofol (Diprivan, Astra-Zeneca, UK). In this paper the possible mechanism was investigated. At first we checked various three-way stopcocks of various manufactures, such as JMS, Terumo, Nipro and Top. ⋯ But there was no significant difference in cracks between fat and propofol groups. The size of crack increased in a time and strength dependent manner. We conclude that the cause of cracks in three-way stopcock is fat emulsion as a vehicle of propofol not propofol itself.
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Case Reports
[Combined intercostal nerve block and epidural anesthesia in a patient with severe aortitis syndrome].
A 74-year-old woman with aortitis syndrome was scheduled for mastectomy. Her left vertebral artery was totally occluded and left carotid arteries, left subclavia artery and bilateral common renal arteries were occluded. For anesthesia a catheter was inserted into the epidural space between T3 and T4. ⋯ Epidural anesthesia alone might be sufficient for anesthesia if higher concentration of local anesthetic was used. However, to avoid hemodynamic change, we used 1% lidocaine and added intercostal nerve block. We conclude that combined intercostal nerve block and epidural anesthesia was useful for a patient with severe aortitis syndrome in oder to monitor consciousness to detect cerebral ischemia and to avoid hemodynamic instability.