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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We investigated the effects of the presence or absence of N2O in propofol anesthesia using a laryngeal mask on the incidence of postoperative sore throat. In the N2O-combined anesthesia group (n = 25), score 0 (no sore throat) was observed in 11 patients; score 1 (slight pain and discomfort that improved on the next day of operation) in 9; and score 2 (persistent pain on the next day) in 5. In the non-N2O-combined anesthesia group (n = 25), score 0 was observed in 21 patients, score 1 in 3; and score 2 in 1, showing a significantly lower incidence of sore throat and milder sore throat than in the N2O-combined anesthesia group. These results suggest that propofol anesthesia using a laryngeal mask not combined with N2O reduces the incidence of postoperative sore throat.
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Thirteen patients were intubated with cuffed reinforced spiral tracheal tubes. Intracuff pressure and volume were measured as the position of the head and neck was altered. No significant changes in intracuff pressure and volume were observed with lateral rotation of the head. ⋯ Reinflated intracuff volume decreased and reinflated intracuff pressure increased significantly, and residual excessive pressure was observed in 4 patients with flexion. Both reinflated intracuff volume and pressure increased significantly, and excessive pressure was observed in 8 patients and residual air-leak developed in a patient in spite of excessive pressure with extension. The authors speculate that endotracheal tube movement by changes in head and neck position has effects on intracuff pressure and volume.
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We investigated the effects of combined inhalational and lumbar epidural anesthesia on body temperature in 8 women for long-lasting lower abdominal surgery. Probes for forehead deep temperature and skin-surface temperatures were placed on the forehead, forearm, fingertip and toe tip on patients' arrival at the operating room. Tympanic membrane temperature was also measured. ⋯ In conclusion, anesthetics-induced redistribution of body heat significantly affects the core temperature throughout anesthesia. Peripheral hypothermia results in core temperature drop when the redistribution is induced by anesthetics. Thermoregulatory vasoconstriction may not only suppress heat loss but also increase core temperature through centralization of body heat.
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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.