Masui. The Japanese journal of anesthesiology
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Case Reports
[Evaluation of epidural blood patch in the treatment of two cases of spontaneous intracranial hypotension].
We evaluated the effect of epidural blood patch (EBP) in the treatment of two cases of spontaneous intracranial hypotension (SIH). Both case 1 (53-year old female) and case 2 (44-year old female) had severe postural headache and showed meningeal thickening by cranial MRI, and were diagnosed as SIH. Case 1: Although her intracranial pressure remained within normal ranges, an extradural leakage was shown in the middle thoracic region on isotope cisternography using indium-111 labeled DTPA. ⋯ Case 2: Her intracranial pressure was low (0 mmH2O on supine position), but, isotope cisternography using DTPA showed only the early appearance of isotope in the bladder but failed to disclose the site of the CSF leak. Epidural blood patch with 30 ml of autologous blood was performed at Th 12-L 1 level which only resulted in severe backache without clinical improvement. In conclusion, we could not find the effectiveness of EBP on the two cases of SIH, although there are many reports on its efficacy.
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Case Reports
[Epidural anesthesia for cesarean section in a twin pregnant patient with severe aortic stenosis].
A 35-year-old twin primigravida with aortic stenosis underwent cesarean section under epidural anesthesia. She had her ventricular septal defect repaired at 3 years of age. Preoperative ultrasonic study revealed severe aortic stenosis in which valve area was 0.77 cm2 and pressure gradient between the left ventricle and the aorta was 80 mmHg. ⋯ Otherwise, peripartal hemodynamics was stable, and she was transferred to the intensive care unit (ICU). Postoperative pain was controlled with epidural infusion of fentanyl. She did not complain of chest pain perioperatively and was discharged from the ICU next day.
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A 65-year-old female with pulmonary tuberculosis and systemic sarcoidosis developed sudden cardiac arrest after the use of bone cement in cementedendoprosthesis of the femoral head. Cardiac arrest was difficult to manage with ordinary CPR and PCPS was immediately instituted. ⋯ The patient required ventilatory support over next 7 days, but survived without neurological sequelae. When anesthetizing an elderly patient with preexisting cardiopulmonary disease for cementedendoprosthesis, PCPS should be considered in case of cardiac arrest due to the use of bone cement.
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Randomized Controlled Trial Clinical Trial
[The effect of epidural saline injection on analgesic level during combined spinal and epidural anesthesia].
The purpose of this study is to clarify the volume effect of epidural saline injection 20 min after spinal anesthesia. Thirty patients undergoing combined spinal and epidural anesthesia for orthopedic surgery were randomly divided into two groups: a control group (n = 15) and a saline group (n = 15). In the control group, 2% lidocaine 3 ml with 0.4% tetracaine was injected into the subarachnoid space from L 4-5 interspace using Durasafe (Becton Dickinson, USA) and saline was not injected into the epidural space. ⋯ However, the levels of analgesia 3, 5, 10, 40 and 100 min after epidural saline injection in the saline group were significantly higher than those in the control group (P < 0.05). The highest analgesic level was obtained 10 min after epidural saline injection and reached to T 4.3 +/- 1.1. In conclusion, epidural saline injection increases the analgesic level 20 min after spinal anesthesia because of the volume effect.
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Randomized Controlled Trial Multicenter Study Clinical Trial
[Total intravenous anesthesia with propofol is advantageous than thiopental-sevoflurane anesthesia in the recovery phase].
A randomized, prospective and multi-institutional study was performed to investigate whether different anesthetic methods affected differently the quality of recovery from anesthesia. Two hundred and eleven patients were allocated to one of two groups; total intravenous anesthesia (TIVA) with propofol and fentanyl (group P, n = 107) and general anesthesia with thiopental, sevoflurane and nitrous oxide (group TS, n = 104). ⋯ The postoperative incidence of vomiting was not significantly different between the two groups (3.7% in the group P and 9.6% in the group TS), but the postoperative incidences of nausea and headache were significantly lower in the group P compared with the group TS (10.3%, 17.8%, respectively in the group P and 34.6%, 29.8%, respectively in the group TS). We conclude that TIVA with propofol is advantageous than thiopental-sevoflurane anesthesia in the recovery phase.