Masui. The Japanese journal of anesthesiology
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Comparative Study Clinical Trial Controlled Clinical Trial
[Is local anesthesia necessary for spinal needle insertion?].
It is a routine procedure for anesthesiologists to use local anesthesia (LA) before spinal needle insertion (SNI), but LA itself produces pain on injection. We evaluated the necessity of LA before spinal block using a 25-gauge needle by questioning whether LA makes SNI painless and easy. Sixty patients without lumbar abnormality for spinal block were allocated to 3 groups: Group A, LA with 2 ml of 1% lidocaine using a 24-gauge needle; Group B, LA with 0.5 ml of 1% lidocaine using a 27-gauge needle; Group C, without LA. ⋯ The times needed for SNI were not significantly different among the three Groups. In conclusion, LA with 2 ml of 1% lidocaine using a 24-gauge needle is not useful for pain relief on spinal block using a 25-gauge needle. Intradermal anesthesia using a 27-gauge needle is preferable to reduce the pain on SNI, if LA is necessary.
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Comparative Study Clinical Trial
[Assessment of postoperative pain using face scale judged by nurses: comparison between hepatectomy and esophagectomy].
The agreement between scores for observer-reported face scale (FS) and the self-reported visual analog scale (VAS) in postoperative pain assessment has not been compared for different types of surgery and for different times in the postoperative course. Five grade FS (1-5) judged by a nurse was compared with VAS (0-100 mm) reported by patients who had undergone hepatectomy (group H, n = 60) or esophageal cancer surgery by a thoracoabdominal procedure (group E, n = 50). Postoperative analgesia was mainly achieved by epidural morphine administration combined with lidocaine or bupivacaine in both groups. ⋯ A fair degree of agreement was found between VAS and FS scores in group H at ICU admission and one hour later (weighted kappa values = 0.29 and 0.28, respectively); on the other hand, good agreement between these two scores was found in group E thirty minutes and one hour after tracheal extubation (weighted kappa values = 0.67 and 0.62, respectively). Weighted kappa values decreased thereafter in group E, but did not change in group H over the postoperative course. We conclude that postoperative pain assessment based on facial expression is more useful early after extubation for patients who have undergone esophagectomy than for those who have undergone hepatectomy.
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A 56-year-old male who had received total thymectomy for treatment of myasthenia gravis was scheduled for sigmoidectomy under general anesthesia. Since his symptoms had become worse after the thymectomy along with increased anti-acetylcholine receptor antibody titer, preoperatively we could not estimate his sensitivity to non-depolarizing muscle relaxants. We initially tried tracheal intubation without using a non-depolarizing muscle relaxant immediately after intravenous injection of propofol 2 mg.kg-1 and fentanyl 4 micrograms.kg-1. ⋯ Successful intubation was performed with 3.5 mg of vecuronium. We conclude that the initial trial of tracheal intubation should be performed without a non-depolarizing muscle relaxant in patients with myasthenia gravis whose symptoms have become worse after thymectomy. If first attempt is unsuccessful, the tracheal intubation should be performed with a smaller dose of vecuronium using an electrical nerve stimulator.
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We reported anesthetic management combined with hypothermia for carotid endarterectomy under somatosensory evoked potential monitoring. Anesthesia was induced by propofol, fentanyl and ketamine, and maintained by infusion of propofol and ketamine and intermittent injections of fentanyl. Perioperative hypothermia was induced by gradually reducing the temperature of a circulating water mattress underneath the body to 15 degrees C. ⋯ No neurological deficits were observed following recovery from anesthesia. Total intravenous anesthesia with propofol, fentanyl and ketamine may be useful for carotid endarterectomy under hypothermia and somatosensory evoked potential monitoring. This method may provide neuronal protection against ischemia injuries induced by cross-clamping of the carotid artery.
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We report a patient in whom urinary retention as a transient neurologic symptoms (TNS) developed after accidental total spinal anesthesia with mepivacaine hydrochloride. Mepivacaine, an amide local anesthetic, has been used for spinal anesthesia and considered one of the best for spinal anesthesia for its low incidence of TNS. However, we suggest that TNS associated with mepivacaine might not be a rare complication in spinal anesthesia.