Masui. The Japanese journal of anesthesiology
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Case Reports
[Complications of spinal anesthesia as the initial symptom in patients with spinal tumor--a report of two cases].
This report describes the onset of symptoms of spinal cord compression by tumor after spinal anesthesia. Two patients underwent caesarean section. Postoperatively, they complained of backache and heaviness in the legs. ⋯ In another case, operation was not performed, but the patient recovered gradually. Onset of symptoms of spinal cord compression by tumor after lumbar puncture can be attributed to displacement of the mass or to vascular engorgement. If after the lumbar puncture, a patient complains numbness, loss of strength, and paresthesias in the legs, we should suspect the presence of the spinal tumor.
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Duchenne's muscular dystrophy is a genetic disorder whose features include abnormal responses to muscular relaxants and possible respiratory dysfunction after general anesthesia. The purpose of this report is to describe one management strategy used successfully to anesthetize an obese man with this disorder for atypical mastectomy. ⋯ Postoperatively 0.25% bupivacaine was infused for epidural analgesia. The patient was observed in the intensive care unit until the first postoperative day and showed an uncomplicated intra- and post-operative course.
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Randomized Controlled Trial Clinical Trial
[Extent and duration of isobaric 0.5% bupivacaine spinal anesthesia by using new open-end pencil point spinal needle].
Extent and duration of isobaric 0.5% bupivacaine spinal anesthesia by using two spinal needles; a new 25 gauge open-end pencil point spinal needle (needle tip is open as a hole after pulling out the stylet, Doctor Japan Co., Japan) and a 25 gauge Quincke needle (TOP Co., Japan) were studied clinically in 24 patients for elective lower extremity surgery. Patients were randomly assigned into two groups of 12 patients each according to the spinal needle used. Lumbar puncture was performed between L3-4 with the patient in lateral decubitus position. ⋯ Two groups did not differ significantly in sensory block and also in motor block. No adverse effect was observed in both groups. These results indicate that this new open-end pencil point spinal needle is very useful for preventing adverse effects of spinal anesthesia.
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We measured plasma concentrations of lidocaine and its principal metabolite, monoethylglycinexylidide (MEGX) associated with thoracic epidural anesthesia using continuous infusion of lidocaine in 10 patients for hepatectomy and other 10 patients for elective abdominal surgery as a control. Plasma concentrations of lidocaine and MEGX were analysed by fluorescence polarization immunoassay and high performance liquid chromatography, respectively. ⋯ Our findings suggest that MEGX formation by the hepatic cytochrome P-450 system might be impaired associated with hepatic surgery. Hypoperfusion of the liver induced by surgical manipulation may have contributed to this impaired metabolism.
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We evaluated mortality of 2689 patients admitted to the Intensive Care Unit, Osaka University Hospital from January, 1987 to December, 1998. The patients were divided into 3 groups. Group A consisted of 1408 patients who underwent cardiovascular surgery, group B, 1082 patients who underwent other surgical procedures and group C, 199 patients who were transferred from the department of medicine. ⋯ Thus, length of ICU stay and mortality rate showed a positive correlation (p < 0.0001). The youngest group (age 0-1) showed a significantly higher mortality rate than other age groups (p < 0.0001). As sepsis was the most important cause of death in all the groups, the prevention and treatment of infection are the most important issue in our ICU to reduce mortality rate.