Masui. The Japanese journal of anesthesiology
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Comparative Study Clinical Trial
[Comparison of double-segment technique with single-space technique for cesarean section using combined spinal epidural anesthesia].
In patients scheduled for cesarean section (c-section) using combined spinal epidural anesthesia (CSEA), we compared the cephalad spreading speed during double-segment technique (DST) with that of single-space technique (SST) of CSEA. In the patients of SST group (n = 169), a 17-G Tuohy needle was introduced at the L 3-4, and then a long spinal needle was inserted through the Tuohy needle. In the patients of DST group (n = 16), a Tuohy needle was introduced at the T 11-12, and a spinal needle was inserted at the L 3-4. ⋯ Two patients in SST group, epidural catheterization was not possible. There were no difference in the incidences of hypotension, nausea and dyspnea between the groups. We conclude from these results that DST for CSEA is preferable to SST for c-section.
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Clinical Trial Controlled Clinical Trial
[Induction of anesthesia with propofol injected through a central venous catheter].
We compared propofol injected through a central venous catheter with that through a peripheral cannula from the standpoint of injection pain, induction time and hemodynamic changes. Thirty-nine patients about to receive abdominal surgery, who had central venous catheters inserted via the subclavian vein, were included in this study. General anesthesia was induced with a loading dose of propofol 1 mg.kg-1 followed by an infusion of 10 mg.kg-1.hr-1 into the central vein without carrier intravenous fluid (group A, n = 13), the peripheral vein without carrier intravenous fluid (group B, n = 13) or the peripheral vein with rapid infusion of acetated Ringer's solution (group C, n = 13). ⋯ The mean induction time was significantly shorter in group A (43 +/- 12 sec) than group B (66 +/- 16 sec) or group C (57 +/- 11 sec). There were no differences between each group in hemodynamic changes during induction of anesthesia. Propofol injection via central venous catheter can avoid the injection pain and shorten the induction time.
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We conducted several tests for predicting the difficult intubation airway in 476 patients excluding those with neck disease and anatomical abnormalities. The evaluation was performed using four methods. 1. The size of the tongue in relation to the oral cavity (Mallampani test: M-T). 2. ⋯ The atranto-occipital joint extension (AOJE). Of these four methods, M-T was the best predictor of a difficult airway. However, all of these four methods may be good predictors, employing modified criteria which include M-T = class 2, 3, 4, H-D = less than 3.0 cm, T-D = less than 6.0 cm, and AOJE = less than 35 degrees.